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This survey of Dupuytren patients is covering 2235 patients and is the largest patient survey so far. It assesses the patients’ perception of the quality of counseling and of treatments. Both appear to exhibit considerable room for improvement. For patients it is important to find a doctor who is able to inform them about all treatment options and to advise which treatment is best for the specific situation of the patient; for doctors it is important to understand the patient’s personal preferences.

This chapter discusses the many options of treatment of Dupuytren disease. Ignoring the many incisions we use, the time-honoured surgeries for the actual disease itself include fasciotomy (1787), segmental fasciectomy (1833), ‘limited’ fasciectomy (c1840-50), dermofasciectomy (1931), radical palmar fasciectomy (1950s) and ‘fibre-break’ fasciectomy (1984), with the dates being the year of their introduction. The alternatives, and proposed alternatives, to surgery, some new, some not so new, include splinting, steroid injection, radiotherapy, needle fasciotomy, collagenase, local chemotherapy, systemic chemotherapy and gene therapy.

The application of a splint as a conservative treatment may have a beneficial effect in Dupuytren contracture, but as a postoperative intervention, it has become routine despite a lack of evidence. By resisting the contracture, it should help extend the finger and may help patients feel they can control their disease for which there is no cure. However, recent randomised studies of postoperative night splinting in addition to hand therapy have shown no significant benefit and possibly even a worse result. Thus, the application of a splint in Dupuytren disease remains controversial, and we present opposite views to allow better understanding of the debate.

Severe contracture of the proximal interphalangeal joint (PIPj) is one of the most challenging problems in the treatment of Dupuytren disease. Among all available techniques, surgery seems to be the most appropriate because of the complexity of the nodules and cords at the finger level. It allows the best correction of contracture as compared to other techniques, solves the skin shortage, and provides the best long-term result. However it carries its own risks, sometimes greater than with the other techniques.

Whilst randomised trials can provide robust and clinically essential data, they cannot answer all questions. There are certain aspects about collagenase which we will have to deduce and cannot prove. Some cords are “twigs” and some are “logs”; it is unlikely that one treatment will be equally suitable for both. Suitable outcome measures are not established. There is no established broadly agreed scoring scheme for Dupuytren disease. One cannot, for example, balance a lower recurrence rate with surgery with the prompter recovery from PNF or collagenase, nor the higher complication rate with surgery against the lower cost of collagenase nor the very cheap cost of needle fasciotomy. A randomised trial requires equipoise from both the investigators and the subjects; the preconceptions of doctors and patients may compromise equipoise and introduce bias into recruitment. Proper comparative trials cost a vast amount of money so that sourcing adequate funding may be a challenge, particularly since long-term outcomes are required particularly to compare recurrence.

All cellular processes involve energy expenditure and hence can be considered to be active. These include cell migration, proliferation, matrix deposition and remodelling. In Dupuytren disease the key cell is the myofibroblasts, which are responsible for matrix deposition and shortening.

Although health authorities in Germany have proposed that PNF is standard of care in Tubiana stages up to II, this quite obviously does not reflect reality. To find out how many surgeons are offering PNF to their patients, we performed an Internet-based survey. According to our results, approximately 15 % of treatments are needle fasciotomies. Only 20 % of the surgeons stated that they are using this method. In Tubiana stage II, surgeons treating a larger numbers of Dupuytren patients chose PNF significantly more often. Efforts should be undertaken to further popularize this method among hand surgeons.

It is more than 50 years since J.T. Hueston, R.M. McFarlane, and others initiated new research programs focused on optimizing the treatment and understanding the pathogenesis of Dupuytren disease (Hueston 1962; Luck 1959; McFarlane and Jamieson 1966). While we have seen the development of some new treatment alternatives, our understanding of the molecular pathogenesis of this fibrosis has remained at a rudimentary level. The central aim of basic Dupuytren disease research is to gain a detailed mechanistic understanding of how complex genomics interact with unique aspects of the palmar fascia microenvironment to cause fibrotic disease development, progression, and recurrence. One way to achieve this aim is to create representative models of Dupuytren disease development in the laboratory. Such models could be used to identify novel therapeutic targets and provide test beds for optimizing these interventions. To achieve these models, we will need researchers with cutting-edge skills. While diverse arrays of skills are likely to be required, experts in the following three areas may be essential.

Despite different treatment options in Dupuytren disease, recurrence of the finger contractures remains a serious concern and the most important factor to evaluate the success of the treatment. Predicting the chance of recurrence in an individual patient is very difficult. However, the treatment options and postoperative protocol could be altered in patients with a high recurrence risk in order to minimize this. Over the past few years, new insights have arisen regarding factors that might predict this recurrence risk. These insights are combined in the concept of “fibrosis diathesis”, an inherent tendency to form fibrosis in different tissues, including the palmar fascia but supposedly also in joint capsules. Patients with a high fibrosis diathesis are supposed to have a more aggressive disease and thus a high recurrence risk. This chapter gives an overview of clinical and other parameters that have been researched in an attempt to predict the recurrence risk after treatment.

For decades, a low-dose irradiation with X-rays has clinically been documented to exert a beneficial effect on hyperproliferative disorders like the Dupuytren disease (DD) and Ledderhose disease (LD). By contrast, experimental studies to unravel underlying cellular and molecular mechanisms are still at their early stages. Recent data, however, indicate the involvement of radiation-sensitive target cells like mitotic fibroblasts/myofibroblasts, induction of free radicals to impair proliferative activity of these cells, interference with growth factors and cytokines and a reduction of activated immune cells interacting with the inflammatory and proliferative processes. We here aim at briefly describing mechanisms contributing to a modulation of fibrogenic and inflammatory components upon exposure to ionizing radiation.

The eponym for Dupuytren disease was coined because Dupuytren, a French surgeon, performed a surgery using an open transverse incision in 1831 on his patient with a hand contracture. However, Dupuytren disease was actually originally described earlier in 1614 by Felix Plater of Basel. Some reports describe Dupuytren disease even earlier in Orkney and Iceland in the twelfth and thirteenth centuries. Interestingly, Englishman John Hunter reported that Dupuytren disease originated in ligaments and not tendons, in 1777—the year of Dupuytren’s birth. Hunter also suggested that surgical fasciotomy might be done to resolve the contractures (Elliot 1989). The introduction of collagenase for the treatment of Dupuytren disease is a much more recent event. Doctors Hurst and Badalamente invented this therapeutic option for treating Dupuytren disease with collagenase and have championed its development since the early 1990s (Hurst 2011).

Historically, Dupuytren research has been guided by surgical research approaches. Surgical research is valuable in refining technical care of acute, limited duration, or nonprogressive conditions. Surgical research tools have helped refine procedural care of Dupuytren contracture, but are not sufficient to address the larger, chronic progressive issues of Dupuytren disease. Biomarker-guided research using approaches developed for chronic disease research is needed to advance the care of Dupuytren disease. Recommendations are provided based on experience reviewing demographics from a large series of Dupuytren interview data from a single clinical practice.

Introduction: The Federal Drug Administration (FDA) approved the use of collagenase clostridium histolyticum (CCH) in the United States in February 2010. This study addresses the impact of that approval on the diagnosis of Dupuytren disease and the effect of CCH on Dupuytren contracture (DC) treatment patterns in the United States.

Currently two minimally invasive treatments are available for Dupuytren contractures: percutaneous needle fasciotomy (PNF) and injection therapy with collagenase derived from Clostridium histolyticum bacteria. In this chapter both techniques will be discussed and their advantages and disadvantages scrutinized, based on analysis of available literature.

The cellular mechanisms producing Dupuytren contracture are not fully understood. The case is made here that there are two possible mechanisms of myofibroblast-mediated tissue contraction and that Dupuytren contracture is passive, produced by isometric contraction guided by tissue slack rather than an active deformation produced by isotonic contraction. The concept of passive Dupuytren contraction was initially proposed by Meinel in 1994, based on anatomic dissections (Meinel 1994). It remains a useful framework to understand the deformity of Dupuytren contracture (Meinel 2012, 2013) and is consistent with recent studies of myofibroblast mechanobiology.

Dupuytren disease is a benign inherited fibromatosis of the fascia of the hand and fingers. It leads to progressive contracture, which alters hand function. There is no known “cure” for Dupuytren contracture.

The International Dupuytren Data Bank (IDDB) is a large longitudinal research study of the natural history and laboratory profile of Dupuytren disease. The goal of the IDDB is to create the scientific foundation to logically develop targeted molecular therapy for Dupuytren disease and related conditions. Unlike the majority of prior Dupuytren research, which has focused on technical aspects of procedures for deformity, the IDDB uses chronic disease research methods. The IDDB model is to study the natural history of disease, identify biomarkers of disease subsets, and identify molecular targets to develop disease-modifying biologic treatment to reduce the need for Dupuytren procedures and to reduce comorbidity of all Dupuytren-related conditions.

In Dupuytren contractures, minimal invasive treatment is considered whenever feasible. However, in recurrent disease, surgery can be challenging and complications as damage to nerves or vessels are an immanent risk. Therefore, whenever surgery is considered, recurrence should be avoided if possible. Minimal invasive surgery is not clearly prone to recurrence, and more invasive procedures do not guarantee an indefinite result. However, skin involvement may play a role in recurrent contractures, and therefore, skin resection and full-thickness grafting may prevent recurrence. In this chapter, the role of the skin and recurrence after full-thickness grafting is explored. The hypothesis that recurrence after fasciectomy and full-thickness skin grafting for correction of Dupuytren contractures is nonexistent was investigated in a long-term follow-up study at our hand unit and compared with earlier results. Although some controversy remains in primary treatment, evidence is increasing to certainly consider the use of the full-thickness skin grafting for Dupuytren disease control in recurrent contractures, as to avoid severe recurrent disease and the need for complex revision surgery.

The closing session at the May 2015 International Conference on Dupuytren Disease and Related Diseases in Groningen, The Netherlands, was on the topic of clinical research. The distinguished panel members of this session were Joseph Dias, M.D., Leicester General Hospital, United Kingdom; Charles Eaton, M.D., Palm Springs, Florida, USA, and founder of the Dupuytren Foundation; and Steven Coleman, M.D., Brisbane Hand and Upper Limb Clinic, Brisbane, Australia. The session was chaired by Marie A. Badalamente, Ph.D., Stony Brook University Medical Center, Stony Brook, New York, USA.

Australia is a long way from everywhere, which makes large database research difficult. Australia has a population of approximately 25 million, and as the country was populated by European migration around 200 years ago, the majority of the current population is of European ancestry. There is thus a high incidence of Dupuytren disease. The nearest continents to Australia are Asia and Antarctica, neither of which has a very high incidence of Dupuytren patients within them. In order to conduct any research of significance into Dupuytren disease it will require an association with larger population groups.

Purpose The purpose of this study was to compare the use of a combination treatment of needle aponeurotomy (NA) and injected steroids with NA alone for patients with Dupuytren disease (DD).

The continuous extension technique (TEC) is a device that can be used for treating finger(s) that are severely contracted due to progressive Dupuytren disease. TEC methodology is an alternative to amputation. The TEC device is an external fixation system able to extend the retracted digito-palmar aponeurosis, the skin and soft tissues of the finger(s) back to as they were at the first stage of the disease. The continuous minimally traumatic and painless lengthening of the skin and fascia produces a regenerative action on the retracted skin and ligaments of digital joints. After its positioning, a 2 mm continuous extension is performed daily by the patient himself for 3 weeks. At the end of the treatment, the finger and its structures are completely extended, the device is removed and at the same time a simple fasciectomy is performed, if necessary.

Dupuytren disease is a well-known hand pathology whose treatment is currently intensely debated. Recently the use of collagenase Clostridium histolyticum (CCH) establishes itself for safety and efficacy. Postoperative splinting after open approaches is widely used and, like many interventions in hand rehabilitation, is supported only by clinical reasoning and anecdotal evidence. Our experience on splinting after CCH injection examines the real benefits of using a dorsal dynamic tension-free splint, considering the absence of a wound and of scar retraction risk.

In Dupuytren disease, treatment is focused on contracture release. Minimal invasive treatment is often chosen whenever feasible. Today, needle fasciotomy, collagenase injections, and limited fasciectomy are widespread primary treatment options if fingers have lost full extension. After invasive treatment to address contractures, rehabilitation can be challenging and both intraoperative and postoperative complications are not uncommon with recurrent contractures in up to 60 % after fasciectomy. Up to now, recurrence remains unpredictable and can result from Dupuytren disease or postoperative scarring, which cannot always be clearly distinguished. Postoperative splinting is often used and even more debated, but literature about splinting as a nonsurgical treatment is limited. In this chapter, a literature overview of the translational background and clinical reports with our single-center experience on corrective splinting in Dupuytren contractures is presented.

Hypothesis: Recurrence following surgical treatment of Dupuytren disease remains a common problem. We hypothesize that the use of acellular dermal matrix is associated with decreased recurrence rates in Dupuytren disease.

The first question to consider when thinking about how to fund future research into Dupuytren disease is what type of research do we wish to perform? Translational research covers the entire spectrum from basic laboratory research into fundamental genetics, cellular signalling pathways and cell biology; through epidemiological studies of environmental predisposition to disease; past studies of new potential treatments or preventative strategies (often first-in-man studies); to comparative studies of current treatments to determine the cost-utility of each form of treatment. All of these areas of enquiry have merit, and each can make a contribution to the understanding of Dupuytren disease; so how can we prioritize which areas are funded?

Background/aimDupuytren disease is a fibroproliferative hand condition. The role of exposure to vibration as a risk factor has been studied with contradictory results. Since field hockey is expected to be a strong source of hand-arm vibration, we hypothesised that long-term exposure to field hockey is associated with Dupuytren disease.MethodsIn this cross-sectional cohort study, the hands of 169 male field hockey players (IQR: 65–71 years) and 156 male controls (IQR: 59–71 years) were examined for signs of Dupuytren disease. Details about their age, lifestyle factors, medical history, employment history and leisure activities were gathered. Prior to the analyses, the groups were balanced in risk factors using propensity score matching. The association between field hockey and Dupuytren disease was determined using a subject-specific generalised linear mixed model with a binomial distribution and logit link function (matched pairs analysis).ResultsDupuytren disease was observed in 51.7% of the field hockey players, and in 13.8% of the controls. After propensity score matching, field hockey playing as dichotomous variable, was associated with Dupuytren disease (OR=9.42, 95% CI 3.01 to 29.53). A linear dose-response effect of field hockey (hours/week x years) within the field hockey players could not be demonstrated (OR=1.03, 95% CI 0.68 to 1.56).DiscussionWe found that field hockey playing has a strong association with the presence of Dupuytren disease. Clinicians in sports medicine should be alert to this less common diagnosis in this sport.

Dupuytren disease in children younger than 10 years is rare and only 8 histologically proven cases have been reported. A histologically proven Dupuytren disease in a 10-year-old with an uncommon clinical presentation as a nodule on the radial side of the middle phalanx of the little finger is documented. Dupuytren's disease should be in the differential diagnosis in cases of nodules and contractures in the palm and fingers of children.

Purpose 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.Methods 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.Results 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.Conclusions 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. (Copyright (C) 2016 by the American Society for Surgery of the Hand. All rights reserved.)

Dupuytren disease (DD) is a benign, generally painless connective tissue disorder affecting the palmar fascia that leads to progressive hand contractures. Mediated by myofibroblasts, the disease most commonly begins as a nodule in the palm or finger, and can progress where pathologic cords form leading to progressive flexion deformity of the involved fingers. The palmar skin overlying the cords may become excessively calloused and contracted and involved joints may develop periarticular fibrosis. Although there is no cure, the sequellae of this affliction can be corrected. This article focuses on the role of collagen in DD and the development of a collagen-specific enzymatic treatment for DD contractures.

A 62-year-old man underwent uncomplicated dermofasciectomy of the right little finger. In the week after surgery, he presented with erythema, tenderness, reduced range of movement, and a chalklike discharge from the suture line. Investigations revealed a raised serum urate level accompanied with a borderline rise in inflammatory markers. A diagnosis of acute gout was made. The patient was managed with nonsteroidal anti-inflammatory drugs. Clinicians should consider the diagnosis of gout when patients present after surgery with redness, pain, and swelling and also consider measuring urate levels before surgery and initiating colchicine prophylaxis when there is a known diagnosis of gout before surgery. Accurate diagnosis may prevent unnecessary antibiotic use.

Diabetes mellitus is associated with the development of several pathologic conditions of the hand, including carpal tunnel syndrome, Dupuytren disease, trigger digits, and limited joint mobility or cheiroarthropathy. In recent years, across a variety of surgical disciplines, increased emphasis has been placed on the impact of diabetes on treatment outcomes. This review provides an overview of the current literature regarding the effect of diabetes on outcomes of hand surgery for these common diabetes-related conditions. Taken as a whole, the best current evidence supports the efficacy of surgical interventions for the management of these conditions in diabetic individuals; however, additional research is required to determine whether the treatment outcomes are equivalent to those of nondiabetic patients, and whether diabetes is associated with an increased risk of complications.

Background: Surgical resection of Dupuytren contracture is fraught with morbidity and prolonged recovery. This article introduces a novel minimally invasive alternative for Dupuytren disease and its outcome. Methods: The procedure consists of an extensive percutaneous aponeurotomy that completely disintegrates the cord and separates it from the dermis. Subsequently, the resultant loosened structure is grafted with autologous lipoaspirate. After 1 week of postoperative extension splinting, patients are allowed normal hand use and are advised to use night splints for 3 to 6 months. The authors treated and report on their experience with 91 patients (99 hands) operated on in Miami and Rotterdam; from 50 patients, the authors report on goniometry (average follow-up, 44 weeks). Results: The contracture from the proximal interphalangeal joint improved significantly from 61 degrees to 27 degrees, and contracture from the metacarpophalangeal joint improved from 37 degrees to -5 degrees. Ninety-four percent of patients returned to normal use of the hand within 2 to 4 weeks and 95 percent were very satisfied with the result. No new scars were added, and a supple palmar fat pad was mostly restored. Complications were digital nerve injury in one patient, postoperative wound infection in one patient, and complex regional pain syndrome in four patients. Conclusions: This new minimally invasive technique shortens recovery time, adds to the deficient subcutaneous fat, and leads to scarless supple skin. By its ability to treat multiple rays, it addresses the abnormality in the entire hand. The procedure is safe and effective, especially for primary cases. Currently, comparative prospective randomized studies are in process to fully determine its role in the treatment of Dupuytren contracture. (Plast. Reconstr. Surg. 128: 221, 2011.)

Dupuytren disease (DD) is a common fibroproliferative disease of unknown etiopathogenesis affecting the palmar aponeurosis, causing reduced hand function and resulting in fixed flexion contractures of the digits. Current gold standard treatment for the management of DD is surgical excision involving removal of the affected palmar fascial tissue. However, there are potential complications associated with surgery as it is costly and a positive surgical outcome is often short-lived because the disease tends to recur. Therefore, there is growing interest in nonsurgical, outpatient-based treatments that could be quicker, cheaper, reduce morbidity, show a decreased rate of recurrence, and give DD patients an improved quality of life when compared with traditional surgical management. Of the available nonsurgical options, injectable Clostridium histolyticum collagenase (CHC) has received recent clinical interest. In this article, a brief overview of DD surgical and nonsurgical treatments utilized is given, followed by a detailed examination of the nine papers published to date on the use of CHC in DD (and similar fibrotic disorders). These papers have investigated safe and efficacious doses for the injection of CHC to treat palpable DD cords in adult patients and have shown significant short- to mid-term results for correction to near-full digital extension (≤5° extension) following CHC injection of DD cords. CHC has been shown to target the collagen-based DD cords while sparing surrounding neurovasculature, with a complication profile that appears comparable to that of the surgical methods currently utilized. In conclusion, clostridial collagenase is a novel nonsurgical treatment option of considerable potential in the management of DD when administered by specialist hand surgeons with detailed knowledge of the disease and the relevant anatomy. Nonetheless, there is a need for further data on long-term results, complications, and rate of recurrence with the use of this emerging treatment option.

NHS England plans to restrict funding for 17 procedures that it considers unnecessary, to save money and eliminate unwarranted clinical variation.12 The policy is supposedly based on best clinical evidence and endorsed by the National Institute for Health and Care Excellence and the Academy of Medical Royal Colleges. Carpal tunnel syndrome, Dupuytren disease, and trigger finger are common and have a substantial …

The "Jacobsen flap" technique: a safe, simple surgical procedure to treat Dupuytren disease of the little finger in advanced stage. Tripoli M, Cordova A, Moschella F. Source Chirurgia Plastica e Ricostruttiva, Dipartimento di Discipline Chirurgiche ed Oncologiche, Università degli Studi di Palermo, Italy. matripoli@yahoo.it Abstract The surgery for advanced stages of Dupuytren disease of the little finger is controversial. In the literature, several techniques have been described with variable reported results and postoperative complications. Percutaneous needle fasciotomy, McCash technique, and dermofasciectomy are often performed for surgical treatment but they present significant complications and limits. This study reviews our experience of using the Jacobsen flap technique, a modification of the McCash procedure. We found that the Jacobsen flap technique for the significant correction of the contracture, the low rate of complications, and the relatively simple surgical approach is an excellent alternative to percutaneous needle fasciotomy, dermofasciectomy, or amputation.

IntroductionDupuytren’s contracture (DC) is a chronic fibroproliferative disorder of the palmar fascia which leads to flexion contracture in one or more fingers. There is no definitive cure for DC, and treatment aims at relieving symptoms by releasing the contracture using percutaneous or operative techniques.Methods and analysisWe planned a prospective, randomised, controlled, outcome assessor-blinded, three-armed parallel 1:1:1, multicentre trial comparing the effectiveness and cost of (1) collagenase clostridium histolyticum injection followed by limited fasciectomy in non-responsive cases, (2) percutaneous needle fasciotomy followed by limited fasciectomy in non-responsive cases and (3) primary limited fasciectomy during short-term and long-term follow-up for Tubiana I–III stages DC. We will recruit participants from seven national centres in Finland. Primary outcome is the rate of success in the treatment arm at 5 years after recruitment. Success is a composite outcome comprising (1) at least 50% contracture release from the date of recruitment and (2) participants in a patient-accepted symptom state (PASS). Secondary outcomes are (1) angle of contracture, (2) quick disabilities of the arm, a shoulder and hand outcome measure (QuickDASH), (3) perceived hand function, (4) EQ-5D-3L, (5) rate of major adverse events, (6) patient’s trust of the treatment, (7) global rating, (8) rate of PASS, (9) rate of minimal clinically important improvement, (10) expenses, (11) progression of disease, (12) progression-free survival, (13) favoured treatment modality, (14) patients achieving full contracture release and >50% improvement and (15) patient satisfaction with the treatment effect. Predictive factors for achieving the PASS will also be analysed.Ethics and disseminationThe protocol was approved by the Tampere University Hospital Institutional Review Board and Finnish Medicine Agency. The study will be performed according to the principles of good clinical practice. The results of the trial will be disseminated as published articles in peer-reviewed journals.Trial registration numberNCT03192020; Pre-results.

Objetivo: Analizar mediante un estudio observacional descriptivo, la frecuencia de las patologias observadas en una consulta de cirugia de mano. Material y metodo: Estudio observacional descriptivo, de una serie consecutiva de 400 pacientes visitados en una consulta de cirugia de mano, analizando estadisticamente la edad, genero y patologia observada. Resultados: Nueve patologias (artrosis trapecio metacarpiana, enfermedad de Dupuytren, sindrome del tunel carpiano, dedo en resorte, epicondilalgia, artrosis de las interfalangicas distales, enfermedad de De Quervain, ganglion de muneca y neuropatia cubital), abarcaron el 75% de todos los pacientes visitados, y el resto (25%), correspondieron a otras 29 patologias diferentes. Del total de pacientes, 237 (59.25%) correspondieron al genero femenino, con una edad media de 56 anos (r = 16-88; DE: 16.89), y 163 (40.75%) al masculino, con una edad media de 48,95 anos (r = 17-79; DE: 17.86). Conclusiones: Si en el 75% de los pacientes visitados en una consulta de cirugia de mano, el grueso de las patologias observadas se circunscriben a nueve, es posible incidir en ellas para que la ensenanza de nuestros residentes y medicos en general sea la mas adecuada. Purpose: To analyze by means of a descriptive observational study, the frequency of the pathologies observed in a clinic hand unit Material and method: Study observational and descriptive, of a consecutive series of 400 patients visited in a consultation of clinic hand unit, analyzing statistically the age, gender and observed pathology. Results: Nine pathologies (trapeciometacarpal joint arthrosis, Dupuytren disease, carpal tunnel syndrome, trigger finger, epycondilitis, distal interphalangeal joint arthrosis, DeQuervain tendynitis, ganglion of the wrist and ulnar neuropathy), included 75% of all the visited patients, and the rest (25%), corresponded to other 29 different pathologies. Of the total of patients, 237 (59,25%) they were female, with an average age of 56 years (r = 16-88; OF: 16.89), and 163 (40,75%) they were male, with an average age of 48.95 years (r = 17-79; OF: 17.86). Conclusions: If in 75% of the patients visited in a clinic hand unit, the thickness of the observed pathologies is confined to nine, is possible to affect them so that the education of our residents and doctors, in general, is adapted.

The Dupuytren contracture - degenerative shortening of the palmar aponeurosis - is a common disease of the hand in Europe. The aetiology of the degenerative changes in the collagen structures is still not clear. To describe the clinical manifestation of the disease we use an international classification according to Iselin. Our hypothesis was that in Dupuytren disease there is a clear pathological abnormality in the tissue elements building up the palmar aponeurosis, which is responsible for the disease, and could be monitored besides the classical histological methods by differential scanning calorimetry.

Purpose of reviewDupuytren disease is a condition of the hand characterized by fibroblastic proliferation of the palmar fascia leading to flexion contracture deformities. This is a review of recent advances made in the exploration of underlying causes of Dupuytren disease as well as in its m

La estomatología se define como una especialidad médica que se ocupa del tratamiento de enfermedades bucales y adyacentes. Al igual que los odontólogos, estos profesionales están expuestos a diversos riesgos laborales, tales como movimientos repetitivos, posturas forzadas, fatiga física y mental. Caso Clínico: Hombre de 56 años, con antecedentes de hipertensión arterial, tabaquismo, dislipemia, queratosis actínica en cuero cabelludo. Presenta desde el año 2006 de forma reiterada, lesión tendinoflexora en mano derecha, valorados por el servicio de prevención de riesgos laborales, recibe tratamiento rehabilitador con escasa mejoría clínica y múltiples recidivas. En vista de dicha evolución se decide intervención quirúrgica del tendón flexor del 2º dedo de mano derecha con el diagnóstico de Enfermedad de Dupuytren. Posteriormente se propone al Instituto Nacional de Seguridad Social (INSS) una Enfermedad Profesional, por tratarse de un trastorno derivado de la actividad laboral, siendo reconocida en el 2007. Por las múltiples complicaciones a pesar de tratamiento médico y quirúrgico y los días de baja en la empresa, el INSS propone una incapacidad permanente total para la profesión habitual, con respuesta favorable. El análisis del caso, permite estudiar la evolución de patologías en los trabajadores, relacionando el origen de las mismas con su actividad laboral, destacando la conducta a seguir si ese padecimiento fuese demostrado como enfermedad profesional. Así mismo, permite repasar los tipos de incapacidad que pueden generarse a partir de una enfermedad y sus repercusiones en la vida laboral del trabajador. The stomatology is a medical speciality which consider treatment of mouth diseases and adjacent. As the odontologists, they are exposed to diverse occupational risk, such as repetitive movements, forced positions, physical and mental fatigue. Clinical case: 56 years old Man, with precedents of arterial hypertension, smoking, dyslipidemia, actinic queratosis in scalp. He continuously presents since 2006, tendon flexor injury in the right hand, valued by the service of prevention of occupational risks, receives treatment with poor clinical improvement and many recurrences. Since the above mentioned evolution, it was decided surgical intervention of the flexor tendon of 2nd finger of right hand with the diagnosis of Dupuytren's Disease. Later it is proposed to the National Institute of Health Service (INSS) an Occupational Disease, for a disorder derived from the occupational activity, which is admitted in 2007. For the multiple complications in spite of medical and surgical treatment and the days of sick leave in the company, the INSS proposes a permanent total incapacity for the usual profession, with favourable response. The analysis of the case, allows studying the evolution of pathologies in workers, relating the origin of the diseases with the occupational activity, emphasizing the courses of action if this suffering could be demonstrated as occupational disease. It also allows reviewing the different types of disability that can be generated from a disease and its repercussions in the occupational life of the worker.

Dupuytren disease is an incurable fibromatosis of the palmar fascia with variable phenotype and disease course. Abnormal fibroblast activity leads to the formation of nodules and myofibroblast activity to the formation of skin pits and cords that may cause flexion contractions. It affects predominantly white males of over 50 years of age and is caused by a combination of genetic and environment causes. Treatment is indicated for painful nodules and progressive finger flexion deformities and can be injection (steroids for nodules; collagenase for cords), radiotherapy (for nodules and very early cords) or surgical (percutaneous or open fasciotomy, limited fasciectomy or dermofasciectomy). Skin defects can be closed by full-thickness skin grafts or left to heal secondarily. The surgical treatment modalities show an inverse relation between degree of invasiveness and durability. This chapter gives an overview of the current knowledge on this subject.