Treatment of Dupuytren's contracture at the proximal interphalangeal joint of the little finger

Abstract

Objective To explore the treatment options for Dupuytren's contracture at the proximal interphalangeal(PIP)joint of the little finger.Methods Since 2000,15 fingers in 9 such cases have been treated.The surgery included Z-plasty of the skin on the volar side of the little finger,extended excision of palmar aponeurosis,excision of the central cord,spiral cord,lateral digital sheet,aponeurosis that extends from hypothenar muscle towards PIP joint of the little finger and ossified aponeurosis at the little finger PIP joint. Results The aponeurosis that extends from hypothenar muscle towards PIP joint of the little finger was found intraoperatively to be the major factor that caused flexion contracture of the little finger PIP joint.Wound healing was uneventful in 14 fingers.In 1 finger there was partial skin necrosis which healed after debridement and dressing change.Follow-up ranged from 8 months to 2 years with an average of 1.6 years.The little fingers were fully extended.There was no skin contracture.Flexion and extension of the fingers was near normal.No complications and recurrence were noted.Conclusion Surgical treatment of Dupuytren' s contracture involving PIP joint of the little finger should include excision of the central cord,spiral cord,lateral digital sheet, aponeurosis that extends from hypothenar muscle towards PIP joint of the little finger and ossified aponeurosis at the little finger PIP joint in addition to the superficial volar fascia and palmar aponeurosis to ensure complete release.