Shortening arthrodesis combined with limited fasciectomy in severe recurrent Dupuytren's disease of the fifth finger

Abstract

ObjectiveManagement of recurrent Dupuytren’s disease of the little finger is challenging. Various treatment modalities have been proposed: external fixation, local skin flap, dermofasciectomy, or even amputation. An alternative surgical technique was introduced by Honecker et al. in 2016 and refined by Raimbeau et al. in 2019, consisting in resection of the middle phalanx and shortening arthrodesis. We modified the technique by combining arthrodesis with a limited fasciectomy of the abductor and/or pretendinous cord in the fifth ray to improve cosmetic and functional outcomes. MethodsPatients with severe recurrent Dupuytren’s disease of the little finger (Tubiana stage III/IV) were treated with proximodistal interphalangeal arthrodesis, combined with limited fasciectomy. Range of motion was assessed preoperatively and postoperatively. QuickDASH and a VAS were assessed to determine overall function and pain respectively. Radiographic evaluation was made at 6 and 12 weeks postoperatively. ResultsThirteen patients were eligible for inclusion. Mean age was 69 years (range 49–87). Radiographic consolidation was obtained at a mean 58 days (range 27–97). Full extension of the metacarpophalangeal joint was achieved in 11 patients and full adduction in 12. Mean active flexion was 94° (range 90–100). QuickDASH scores decreased from 18 to 12 after surgery. Pain scores were low and unchanged. ConclusionBy combining proximodistal interphalangeal arthrodesis with limited fasciectomy through a volar approach, finger extension improved, and fixed abduction was also treated. The combined volar and dorsal approach did not induce vascular impairment or other complications.