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      Isolated Small Finger Distal Interphalangeal Joint Dupuytren's Contracture

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          Abstract

          Dupuytren's contracture is a disease involving abnormal myofibroblast proliferation and collagen deposition leading to the formation of pathologic cords in the hand. Given that Dupuytren's contractures rarely extend to the distal interphalangeal joint (DIP), affecting only 5% of patients, there are few cases reported in the literature. Collagenase injection is a frequently used option for minimally invasive treatment of Dupuytren's disease with greater than a 20-degree joint contracture. Unfortunately, there is limited research on the effectiveness of these injections in isolated DIP joint deformities. We present a case of a 61-year-old right hand-dominant male with a 2-year history of isolated right small finger Dupuytren's contracture at the DIP joint who achieved significant improvement after collagenase injection.

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          Most cited references16

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          Dupuytren disease: Anatomy, pathology, presentation, and treatment.

          G Rayan (2006)
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            Dupuytren's disease: history, diagnosis, and treatment.

            After studying this article, the participant should be able to: 1. Describe the clinical features of the disease. 2. Describe the pathoanatomical structures in Dupuytren's disease. 3. Outline the various factors associated with Dupuytren's disease. 4. Describe the modalities for surgical and nonsurgical treatment of the condition. 5. Outline recent biomolecular knowledge about the basis of Dupuytren's disease. Dupuytren's disease is characterized by nodule formation and contracture of the palmar fascia, resulting in flexion deformity of the fingers and loss of hand function. The authors review the historical background, clinical features, and current therapy of Dupuytren's disease; preview treatment innovations; and present molecular data related to Dupuytren's disease. These new findings may improve screening for Dupuytren's disease and provide a better understanding of the disease's pathogenesis.
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              A systematic review of outcomes of fasciotomy, aponeurotomy, and collagenase treatments for Dupuytren's contracture.

              Needle aponeurotomy and collagenase injection are alternative treatments of Dupuytren's contracture to open partial fasciectomy; however, reported data are difficult to interpret without a formal systematic review. A Medline, EMBASE, and Cochrane database search was performed, and 277 articles were identified. Articles were stratified by level of evidence, and those of the highest level for each technique were included. Evidence available for needle aponeurotomy was of low quality so only cohorts larger than 100 patients were included. The sample size of patients for open partial fasciectomy ranged from 37-261. The recurrence rate ranged from 12-39%, with mean follow-up time of 1.5-7.3 years. The complication rate ranged from 14-67%. Complications included nerve division (2-5%), infection (4-12%), neurapraxia (0.4-52%), and regional pain syndrome (2-13%). For needle aponeurotomy the sample size ranged from 117-211. The recurrence rate ranged from 50-58%, with mean follow-up time of 3-5 years. With regard to collagenase injection, the sample size ranged from 13-204. The recurrence rate ranged from 10-31%, with mean follow-up time of 120 days to 4 years. For the two latter procedures, adverse effects consisted primarily of skin tears (9-25%). Kruskal-Wallis testing demonstrated that the recurrence rate was significantly higher for needle aponeurotomy than for open partial fasciectomy (p = 0.001), and the recurrence rate was significantly higher for open partial fasciectomy than for collagenase injection (p = 0.001). The recurrence rates and types of complications differ between open partial fasciectomy and needle aponeurotomy or collagenase injection. Long-term outcomes have not been well reported.
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                Author and article information

                Contributors
                Journal
                Case Rep Orthop
                Case Rep Orthop
                CRIOR
                Case Reports in Orthopedics
                Hindawi
                2090-6749
                2090-6757
                2019
                4 November 2019
                : 2019
                : 7183739
                Affiliations
                1University of Kentucky Department of Orthopedic Surgery and Sports Medicine, Lexington, Kentucky, USA
                2University of Kentucky College of Medicine, Lexington Kentucky, USA
                Author notes

                Academic Editor: Koichi Sairyo

                Author information
                https://orcid.org/0000-0003-0563-7601
                Article
                10.1155/2019/7183739
                6875190
                43c7227a-70c9-4d7f-b4b9-7cacd33507ee
                Copyright © 2019 Syed K. Mehdi et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 27 May 2019
                : 24 August 2019
                : 17 September 2019
                Categories
                Case Report

                Orthopedics
                Orthopedics

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