Tubiana Stage Research Articles

Challenges and innovations in the surgical treatment of advanced Dupuytren disease by percutaneous needle fasciotomy: indications, limitations, and medico-legal implications

BackgroundDupuytren disease, a chronic thickening and retraction of the palmar aponeurosis of the hands, may result in permanent and progressive flexion of one or more fingers. Percutaneous needle fasciotomy is a simple method that uses a hypodermic needle usually performed under local anaesthesia. The study aim was to report the postoperative results and complications using a percutaneous approach to treat Dupuytren contracture in a consecutive series of patients with advanced Dupuytren disease, also considering the relevant medico-legal implications.MethodsRetrospective multicentre study of all patients with Tubiana stage 3–4 Dupuytren contracture treated with percutaneous needle aponeurotomy, with no ultrasound assistance, from 2012 to 2022. Patient demographics, disease severity, treatment-related complications, and the incidence of recurrence were identified. An overview of therapeutic treatment options has accounted for 52 relevant sources spanning the 2007–2023 time period.ResultsOverall, 41.7% (N = 200) of patients were females, the mean age was 72 years (60–89), the right hand was treated in 54.2% (N = 260) of patients. The little finger was involved in 50% of the patients. The 12 months mean PED was 9°, the mean quickDASH was 8, the mean URAM 6. Minor complications were reported in 18.7% (N = 90) of patients, typically skin lacerations (83.3%) with no clinical sequelae, and no major complications were reported. Recurrence occurred in 30% (N = 144) of patients.ConclusionsPercutaneous needle fasciotomy is safe and reliable even in patients with advanced Dupuytren disease, resulting in predictably acceptable outcome with low risk of complications.

Medium-term Results after percutaneous Needle Fasciotomy in Dupuytren's Disease

Dupuytren's disease often leads to an increasing limitation in finger extension in affected patients. As the incidence rises with age, the number of cases is expected to rise in the future due to the demographic change. Therefore, an easy and patient-oriented treatment is required. In the following study, we investigated the short and medium-term results after percutaneous needle fasciotomy (PNF). Overall, 65 fingers of 40 patients were treated with PNF. We evaluated the total passive deficit of extension (TPED), the passive deficit of extension of the joints (PED), the Buck-Gramcko score, rate of recurrence, DASH score and patient satisfaction. The average age of the patients was 65,9 years. Most of the patients (82%) were male. Directly after the PNF, extension in the treated fingers improved significantly (TPED before PNF 74,6°±41,1 SD to 32,8°±29,0 SD after the procedure). By the time of the follow-up examination (30,2±13,9 SD months), TPED had increased again (52,7°±40,2 SD). The rate of recurrence was 29,7%, and a higher Tubiana stage before the procedure correlated significantly with a higher recurrence rate. Nevertheless, patients demonstrated a very high level of satisfaction with the procedure and almost all patients would choose to undergo PNF again. Although it is associated with a relatively high recurrence rate, PNF represents an effective and patient-oriented treatment of Dupuytren's contracture.

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

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.

Patients With Dupuytren Disease Use Excessive Grip Force When Lifting and Holding Small Objects, Independent of the Degree of Contracture

ObjectiveTo identify the extent and quality of fine motor skill alteration in patients with Dupuytren disease (DD) using an instrumented device measuring grip forces, beyond the commonly used measurement of contracture. DesignCase–control study. SettingUniversity outpatient clinic. ParticipantsPatients with DD (N=27) and a contracture >45° (Tubiana stage II, III, and IV) were included and compared with age-matched healthy control patients (N=27). InterventionsNot applicable. Main Outcome Measures(s)All individuals were subjected to a set of specific tests using a new instrumented device (“manipulandum”). These included lifting, grasping, and then holding the “manipulandum” with 4 different object characteristics (light and heavy weight, rough and smooth surface) along with a measurement of the precision grip strength. Standard measurements including the Nine-Hole Peg Test, a two-point discrimination, and the Disability of Arm, Shoulder and Hand score were evaluated in comparison. ResultsAlthough the measurements of precision grip, two-point discrimination, Nine-Hole Peg Test, and Disability of Arm, Shoulder and Hand score showed no statistically significant differences between both groups, patients with DD applied significantly greater forces when tested with the different subtests using the “manipulandum.” Analysis of the 2-phase movement (lifting and holding the “manipulandum”) revealed highly significant differences between the groups. ConclusionsPatients with DD use excessive grip forces when lifting and holding the “manipulandum” when compared with healthy control patients, independent of the degree of contracture. As no differences in precision grip strength were seen, the presented approach is useful to obtain additional important information about fine motor function in diseased hands.

Office-based Percutaneous Needle Fasciotomy for Tubiana Stage 1 and 2 Dupuytren’s Contracture

Purpose Dupuytren’s contracture (DC) is a common condition that causes flexion contracture of the fingers. Many treatment methods have been described for DC. Patients preferred outpatient treatment options during the COVID-19 pandemic, and percutaneous needle fasciotomy (PNF) can be performed in an office setting. This study reports the results of office-based PNF for Tubiana stage 1 and 2 DC. Methods A total of 44 rays in 29 patients (24 males and 5 females) were included. The mean age was 65.2 (49–76) years. Passive extension deficit (PED) of each joint, the visual analog scale (VAS) score for cosmetic appearance, and the Quick-Disabilities of the Arm, Shoulder, and Hand (Q-DASH) questionnaire results were recorded before and after treatment. Complications and recurrence rates were noted. The mean follow-up time was 11.6 (8–16) months. Results The PEDs for the metacarpophalangeal and proximal interphalangeal joints decreased in all patients during the early post-treatment period. Q-DASH and cosmetic VAS scores improved in all patients. The recurrence rate was 18% (8 of 44 rays) and a major complication was observed in one patient (rupture of the flexor digitorum profundus tendon). Conclusion PNF is a relatively simple procedure that can be performed in an office setting. The functional and cosmetic results were satisfactory in this study, with low recurrence and complication rates. Therefore, PNF may be the first choice treatment option for patients with Tubiana stage 1 and 2 DC.

Epidermal Inclusion Cysts following Dupuytren’s Percutaneous Needle Fasciotomy: A Case Report

Summary:Percutaneous needle fasciotomy (PNF) is a favorable approach to Dupuytren’s contracture management, usually reserved for Tubiana stage 1–2, uncomplicated disease. It is growing in popularity globally. Epidermal inclusion cysts are benign, commonly encountered cavities usually found on acral skin, rarely glabrous skin, and often following trauma. We present a 43-year-old laborer with two incidentally found epidermal inclusion cysts in the open excision of painful, Tubiana 3 and 2 Dupuytren’s recurrence of his middle and ring fingers. He had undergone PNF to same 4 years prior. One cyst had ruptured. Both seemed to have migrated distally over time from the initial PNF site with progression of the Dupuytren’s disease. This may be the only case of multiple epidermal inclusion cysts post PNF for Dupuytren’s disease in the literature. The authors discuss factors contributing to epidermal inclusion cyst formation, and postulate whether needle choice may impact the risk of their development as a complication of PNF.

Dupuytren's disease: A reality in Black Africa

Long regarded as a disease exclusively found amongst Northern Europeans, Dupuytren's disease was seldom studied amongst Black Africans. Thus, we sought to study the impact of Dupuytren's disease, its etiological, clinical and evolutionary peculiarities on a segment of the Senegalese population. This study analyzed data derived from clinical observations carried out between January 2006 and December 2018. It involved Senegalese subjects with Dupuytren's disease, the patients’ history, profession, habitus, clinical findings, therapeutic modalities and disease staging. The population included 20 men and 6 women averaging 63.5 years of age (range 45–77). None of the patients reported a family of Dupuytren's disease. Twelve patients had diabetes, 11 were smokers and 22 were engaged exclusively in manual labor. The condition was bilateral in 14 cases. Tubiana stages N, I, II, III and IV were found in 31, 15, 9, 5 and 6 rays, respectively. Conservative treatment was done in 11 patients. Surgical treatment was carried out in the other 15 patients: needle fasciotomy (N=10) including two bilateral involvement and open fasciectomy (N=7). Functional outcomes were satisfactory. Lesions were all stable in the short and medium term. Two patients had progressive lesions on a longer-term basis. Dupuytren's disease is real among Afro-descendants from Senegal even though it is seldom studied. Based on the patients’ recollection of Dupuytren's disease in their families, heredity is not yet a proven factor. The early forms are more common, and the lesions remain stable for a long time.

Ossification hétérotopique calcification d’un cordon de Dupuytren dans un petit doigt ostéoarthritique préalablement traité avec de la collagénase

A 67-year-old right-hand-dominant man presented with Tubiana Stage 2 Dupuytren's Disease of his left, non-dominant, little finger (30° MCPJ and 20° PIPJ flexion contractures). After thorough discussion he elected to proceed with Xiapex® collagenase. At the six month follow-up he had had an early severe recurrence of his to Tubiana Stage 3 (35° MCPJ and 60° PIPJ flexion contractures). Due to the increased deformity the decision was made to proceed to a dermo-fasciectomy. The dermo-fasciectomy was performed as per Heuston from mid lateral to mid lateral on the little finger P1. On excision of the P1 skin and Dupuytren's cord it was noted that there was area of hardened tissue at the volar PIPJ. Intra-operative imaging was undertaken showing osteoarthritis of the DIPJ and PIPJ and an calcific ossific nidus in keeping with the clinical findings. Full excision was achieved and the operation completed as shown with an excellent correction. Histopathology was not undertaken given the intra-operative findings and imaging. The CORDLESS study sites a five year recurrence rate following Xiapex injection of 47%. In comparison recurrence rates in dermo-fasciectomy have been reported from 8 to 13.6%. If a primary dermo-fasciectomy or simple fasciectomy had been performed then it is unlikely that this variant would have been observed as the cord would have been excised. Calcification ossification within resected tissue specimens is rare. Following a review of the literature we believe we are reporting the third case of calcified ossified Dupuytren's contracture, and the first case following Xiapex® injection. Xiapex® injections are becoming increasingly used as a primary management for Dupuytren's contractures. Patients report high satisfaction rates, however fewer patients have tendency towards collagenase injections for recurrent disease. Given the increased incidence of the use of collagenase we felt this case warranted reporting as calcification ossification was noted upon revision surgery. We conclude that the noted calcification ossification is not related to the Xiapex injection, and is probably coincidental. This is the first case of ossification in a Dupuytren's treated with Xiapex® however this is probably coincidental. Calcified Ossified Dupuytren's is a very rare but recognised subtype of Dupuytren's contracture. The presence of calcification ossification does not alter management, however a fasciectomy or dermo-fasciectomy may have been a better initial treatment option in this case.

Outcomes at 7 and 21 years after surgical treatment of Dupuytren's disease by fasciectomy and open-palm technique

The goal of this study was to assess the recurrence of Dupuytren's disease and the stability of the functional result after fasciectomy combined with the McCash open-palm technique. From 1989 to 1999, 56 consecutive patients were surgically treated for Dupuytren's disease. In 2003, 40 of these operated patients were reviewed by an independent evaluator; 12 patients were Tubiana stage 1, 16 stage 2, 9 stage 3 and 3 stage 4. Twenty-one of them were reviewed again in 2016 by a second evaluator who was unaware of the clinical results in 2003. The mean follow-up was 7.32 years (range, 4.26 to 12.5 years) at the first review. Recurrence occurred in 7 patients (17.5%) and extension of the disease in 15 (37.5%). Three patients had developed complex regional pain syndrome (CRPS). Mean residual contracture was 19.3°. Average improvement in finger extension was 53°. At the second review, 21 patients were assessed with a mean follow-up of 21.5 years (range, 18.7 to 26.3 years). None of them were re-operated and no extension of the disease was observed. There was no recurrence in patients who had no recurrence in 2003. However, the contracture had worsened in five patients (23.8%), three of whom had a recurrence of the disease in 2003. Mean residual contracture was 31.8°. Recurrence occurs most often in the first few years after surgery. The functional result is stable over time. CRPS and the number of rays operated are the main factors negatively affecting overall improvement of mobility.

A post hoc analysis of Dupuytren contracture treated with collagenase Clostridium histolyticum across disease stages

This post hoc analysis from a multicenter study (NCT01674634) was designed to evaluate the efficacy of collagenase Clostridium histolyticum (CCH) treatment in patients with different stages of Dupuytren contracture. Previously untreated patients who received two concurrent injections of CCH in two affected joints in the same finger were assessed by disease severity (Tubiana stage). The mean (SD) improvement in total fixed flexion contraction (FFC) 31 days post-CCH treatment in 181 patients was: 71.1 (36.5)% for Tubiana I, 77.0 (21.0)% for Tubiana II, 72.0 (20.4)% for Tubiana III and 66.4 (22.2)% for Tubiana IV. Treatment of metacarpophalangeal and proximal interphalangeal joints in the same finger resulted in a mean (SD) improvement of 82.5 (24.8)% and 66.4 (27.9)%, respectively. In conclusion, CCH is an effective treatment alternative for all stages of Dupuytren contracture and it provides a less invasive treatment alternative to surgery with similar short-term efficacy in patients with more severe disease.

Distal sensory disorders in Dupuytren's disease.

Dupuytren's disease is a common and disabling condition. Its pathophysiology is not well understood. Some patients complain of postoperative loss of fingertip sensitivity that could be due either to the surgery or to the disease itself. Our hypothesis is that distal sensory disorders are a component of Dupuytren's disease. We performed a prospective, single-center study to compare two populations: controls and patients with Dupuytren's disease. Subjects were excluded if they were under 18 years of age or had any disease or treatment that could alter finger sensitivity or test comprehension. Sensitivity was determined using Weber's static two-point discrimination test. Each ray of the tested hand in the Dupuytren's patients was classified as healthy or diseased; the diseased rays were graded using the Tubiana stages and the type of involvement (pure digital, pure palmar, palmar-digital). The study enrolled 56 patients in two comparable groups of 28 patients and 28 controls. A statistically significant difference was found between the affected hands of Dupuytren's patients and the hands of the controls. There was also a significant difference in the mean sensitivity of affected and normal rays in the Dupuytren's patients. Preoperative distal sensory disorders are a component of Dupuytren's disease that could be related to neuropathy and/or mechanical nerve compression. IV, case-control study, diagnostic study.

Preferred treatment options of German hand surgeons in Dupuytren disease

This study was performed to determine whether between 2015 and 2017 there has been a change in the preferred method of treatment of Dupuytren disease by German hand surgeons, especially with respect to percutaneous needle fasciotomy. In 2015 and 2017, 530 members of the German Society for Surgery of the Hand were invited to take part in an online survey, asking for their preferred treatment for Dupuytren disease, including decision criteria and in relation to Tubiana stages. 110 and 101 responders, respectively, took part. In both surveys, 86 surgeons stated that they treated up to 100 patients per year (Group A), while 24 and 15 surgeons, respectively, treated more than 100 Dupuytren patients annually (Group B). In both surveys, limited fasciectomy was found to be the preferred method (82.9 % and 87.7 %). Treatment with clostridial collagenase is performed only sporadically (1.3 % or 1.4 %). Percutaneous needle fasciotomy is of minor relevance in stage I (19.1 % or 10.9 %) and II (16.4 % or 9.9 %) and is performed mainly by surgeons who treat more than 100 patients per year.The most important criterion for the decision on what treatment should be chosen was "best outcome" (54.3 % and 68.6 %). Between 2015 and 2017, there was no great change in the choice of treatment for Dupuytren disease in Germany. In particular, there was no increase in PNF procedures.

Radiotherapy in Dupuytren's disease: a systematic review of the evidence.

II.

Clusters in Short-term Disease Course in Participants With Primary Dupuytren Disease

The course of Dupuytren disease (DD) is thought to be progressive; however, the course differs for each patient. The purpose of this study was to study the rate and pattern of progression of DD. We prospectively analyzed the course of DD at intervals of 3 to 6 months in 247 Dutch participants with primary DD by measuring the surface area of nodules and cords and the total passive extension deficit. The association between surface area and Tubiana stage was tested with generalized estimating equations. Latent class models were used to study different clusters in changes regarding the course of the disease. The variance in disease course between participants was large. Regarding the change in surface area (in all fingers) and total passive extension deficit (in the ring and little finger), different clusters were observed. Progression of disease was seen but there were also signs of stability and even regression. Patients with a smaller surface area at baseline were more likely to exhibit regression. This study showed that DD is not always progressive and that up to 75% of patients have a different short-term disease course, such as stability or even regression of disease. This should be taken into account when evaluating the effects of treatment for early-phase DD and in the design of future studies. Furthermore, this information may be useful when counseling patients. Prognostic II.

Percutaneous needle aponeurotomy for Dupuytren's disease

Percutaneous transverse aponeurotomy of the cord by using a hypodermic needle as a scalpel blade in order to improve function of the hand. Symptomatic flexion contracture with positive table top test caused by a single, palpable cord within the palm (primarily Tubiana stages I and II). Multiple, infiltrating or broad-based cords within the palm; irritated skin conditions; exclusive digital cord localization; recurrence after aponeurectomy; previous surgical intervention at the site of interest, digital nerve lesions; lack of patient compliance. Pinpoint surface anesthesia is obtained by injecting each portal area subdermally with 0.1 ml of local anesthetic. These applications start from distally to proximally within the palm while the most distal injection site is located proximal to the distal palm crease. Then the needle tip is introduced perpendicular to the cord. Sawing movements through the cord are performed transversely. While passively extending the contracted finger, the cord is held under tension which guarantees safe cutting. Patients are encouraged to report immediate pain sensation or numbness in order to prevent injuries to neurovascular structures and active finger flexion excludes tendon lesions during the procedure. Introducing the needle tip may be performed at several sites along the cord, if necessary, from distal to proximal at least 5 mm apart with prior pinpoint surface anesthesia. Finally, cautious passive stretching may be done after each release. Bandaging allowing immediate motion; application of a hand-based extension splint-glove during the night for 3-6 months. Recurrence rate was 53% in 15 retrospectively examined patients after a mean interval of 40 months postoperatively.

Clinical Results of Percutaneous Needle Fasciotomy for Dupuytren's Disease in Japanese Patients.

Background:Clinical results of percutaneous needle fasciotomy (PNF) in Japanese patients with Dupuytren’s disease are reported.Methods:In this prospective study, 51 patients (103 fingers: 1 index, 9 middle, 47 ring, and 46 small) underwent PNF at 99 metacarpophalangeal (MCP) and 68 proximal interphalangeal (PIP) joints. Patients were assessed postoperatively after 1 day, at 1, 2, 4, 6, and 8 weeks, and at 3, 6, 9, and 12 months. Correction of contracture was measured in degrees, and an improvement index (% improvement) was described previously by Tonkin et al. A correction of the contracture to 5° or less at each joint and at each digital ray represented a successful correction. The recurrence rates in MCP and PIP joints were also evaluated. Correlations between the Tubiana classification stage and successful correction, % improvement, and recurrence rate were evaluated. The relationships between recurrence rate and the diathesis score (more/less than 5 points) and between recurrence rate and age at surgery (<50/≥50 years) were also examined.Results:In MCP and PIP joints, the improvement maintained at final follow-up was 89% and 57%, respectively, with successful corrections in 89% and 76%, respectively. PNF corrected digital rays at various Tubiana stages: stage 1 = 100%, stage 2 = 82%, stage 3 = 46%, and stage 4 = 0%. Improvements were preserved in stage 1 = 83%; stage 2 = 62%; stage 3 = 58%, and stage 4 = 60%. Recurrence of Dupuytren’s disease was significant for the PIP joint, severe Tubiana stage, and younger patients.Conclusions:Clinical results of PNF in Japanese patients with Dupuytren’s contractures were similar to those of whites.

Intra- and inter-observer agreement on diagnosis of Dupuytren disease, measurements of severity of contracture, and disease extent

IntroductionDupuytren disease (DD) is a fibrosing disease affecting the palmar aponeurosis, and is mostly treated by surgery based on measurement of severity of flexion contracture of the fingers. Literature concerning the measurement reliability is scarce. This study aimed to determine the intra- and inter-observer agreement of four variables for diagnosing DD, determining severity of contracture, and disease extent. One of them is a new measurement on the area of nodules and cords for measuring the disease extent in early disease stages. MethodsAn agreement study (n = 54) was performed by two trained investigators. Agreement was calculated per finger, based on an intraclass correlation coefficient (ICC) using a latent variable model on subjects for diagnosis and Tubiana stage. For total passive extension deficit (TPED) and the area of nodules and cords, agreement was calculated with an ICC using a one-way random effects model with subject as random effect. ResultsInter-observer agreement was very good for diagnosing DD (ICC: 95.5%–99.9%) and good to very good for classifying Tubiana stage (ICC: 73.5%–94.9%). Agreements for area and TPED were moderate (middle finger) to very good (ICC: 48.4%–98.6% and 45.0%–99.5%, respectively). Intra-observer agreement was slightly higher on average than inter-observer agreement. ConclusionOverall, the intra- and inter-observer agreement in diagnosing DD, and determining the severity of flexion contracture is high. Also, the newly introduced variable area of nodules and cords has high intra- and inter-observer agreement, indicating that it is suitable to measure disease extent.

Current trends in the surgical management of Dupuytren’s disease in Europe: an analysis of patient charts

IntroductionDupuytren’s disease (DD) causes progressive digital flexion contracture and is more common in men of European descent.MethodsOrthopaedic and plastic surgeons in 12 European countries (the Czech Republic, Denmark, Finland, France, Germany, Hungary, Italy, The Netherlands, Poland, Spain, Sweden and the UK) with >3 and <30 years experience reviewed the medical charts of five consecutive patients they had treated surgically for DD in 2008. Descriptive statistics are reported.ResultsIn total, 3,357 patient charts were reviewed. Mean (standard deviation) patient age was 61.9 (10.2) years; 81% were men. At the time of the procedure, 11% of patients were at Tubiana stage Ia (0–20° total flexion); 30%, stage Ib (21–45°); 34%, stage II (46–90°); 17%, stage III (91–135°); and 5%, stage IV (>135°). Percutaneous needle fasciotomy was performed in 10%, fasciotomy in 13%, fasciectomy in 69% and dermofasciectomy (DF) in 6% of patients. After surgery, fingers improved a mean of 1.9 Tubiana stages, and 54% of patients had no nodules or contracture. The rate of reported complications during the procedure was 4% overall (11% in patients undergoing DF). The most common postoperative complications reported were haematoma (8%), wound healing complications (6%) and pain (6%). No postoperative complications were reported in 77% of patients.ConclusionsIn this European study of more than 3,000 patients with DD, most patients were diagnosed at Tubiana stage I or II, the majority received fasciectomy and more than half had no nodules or contracture remaining after surgery.Electronic supplementary materialThe online version of this article (doi:10.1007/s12570-012-0092-z) contains supplementary material, which is available to authorized users.

Results of Surgery Treatment of Dupuytren's Contracture in 115 Patients

Dupuytren's disease (DD) is a progressive fibroproliferative disorder of the hand causing digital flexion contracture. Treatment goals include removing or releasing the fibrotic cord to allow extension of the affected finger(s) and restoration of hand function. In study period from 2001 through 2008, evaluation was performed in 115 patients. Limited or extensive fasciectomy was performed in all patients. Tubiana classification sheme to rate severity of DD was used. There were 106 male patients ( mean age 62.6 years) and 9 female patients (mean age 66.3 years). Before the operation, 38% of all patients were at Tubiana stage I, 32% were at stage II, 22% were at stage III and 8% were at stage IV. Of all patients, 43% were diagnosed with Dupuytren's in only one finger, 39% in two fingers and 18% in three fingers. In 23% of patients DD were diagnosed on both hands. Limited fasciectomy was peformed in 90.4% of patients and extensive fasciectomy in 9.6% of patients. The Tubiana stage achived after surgery was lower in 98% of patients. As a final result after surgery, 66% of patients didn't have contracture, stage I was reported in 28% and stage II in 3% of patients. There were no patients with Tubiana stage III or more after surgery. Postoperative complications were noted in 18% of patients. Wound healing problems were present 12% of patients. Haematoma was reported 5% of patients. Of all patients 22% had diabetes mellitus. DD is much more common in male than in female patients. Most of the patients are diagnosed at Tubiana stage I and II. Surgical correction has led to an improvement in most patients. Limited fasciectomy is still the gold-standard in DD treatment. Extensive fasciectomy or dermofasciectomy is preformed only in most severe cases.