Steroid Injection and Needle Aponeurotomy for Dupuytren Contracture: A Randomized, Controlled Study

Abstract

To compare flexion deformity at 6 months in patients with Dupuytren contracture who had percutaneous needle aponeurotomy (PNA) combined with a series of triamcinolone acetonide (TA) injections to that of patients who had PNA alone. Forty-seven patients with Dupuytren disease who were candidates for PNA (at least 1 contracture of at least 20°) participated in the study. Patients were randomized either to receive TA injections immediately following and 6 weeks and 3 months after the procedure or to receive no injections. Injections were administered into cords. The number of injections and the amount of TA per injection was determined based on the number of digits involved and the cord size. All subjects returned for 3 follow-up visits after the procedure, and contractures were measured using a goniometer. Change in total active extension deficit (TAED) was analyzed using a repeated measures analysis of variance to assess for differences between groups, time points, and interaction between group and time point. Descriptive statistics were calculated for all variables of interest. Continuous measures were summarized using means and standard deviations. There was no significant difference in TAED between groups before cord aponeurotomy. Correction at 6 months was 87% of preoperative TAED for the TA group versus 64% for the control group. This difference was statistically significant. The amount of TA administered did not correlate with TAED improvement. The study group who received TA in combination with PNA experienced a significantly greater degree of correction of flexion deformity at 6 months than those who had PNA alone.