Needle Fasciotomy or Collagenase Injection in the Treatment of Dupuytren’s Contracture : A Retrospective Study

Dupuytren’s contracture is a benign fibroproliferative disease. It develops in about 6% of the older population in Sweden.1 Benign fibromatosis develops in the palmar fascia of the hands and fingers in the form of tough bands in the subdermal level causing flexion contractures, which limit the extension of the affected finger. In 1979, Lermusiaux and Debeyre2 described the use of a needle as a substitute for a blade to disrupt the tough fibrous bands. The method apparently found general acceptance because it is less invasive than open excision, and the function of the hand is usually restored quickly.3–5 Foucher et al3 reported good results, especially for the treatment of the metacarpophalangeal (MCP) joints with a reoperation rate of 24% among the 311 treated fingers. Badois et al6 showed that the recurrence rate was 50% among the 123 hands that were assessed 5 years after treatment. Similar results were reported by van Rijssen et al4 who showed that 50% of the patients remained free of recurrence for a mean of 4.4 years after treatment; however, that study included only 40 fingers. In 2009, collagenase clostridium histolyticum was introduced as an efficient method of treatment of Dupuytren’s contracture, with an overall improvement rate of 64%.7 The use of collagenase increased the total number of patients treated in parallel to a decrease in the number of open fasciectomies.8 Collagenase treatment and needle fasciotomy have some characteristics in common. Both are less invasive than open surgery, so they can be done in the outpatient clinic. In contrast to open surgery, both methods disrupt the cord while leaving the bulk of the pathologic collagen intact.8–11 There have been studies that compared the outcome after the treatment with collagenase or needle fasciotomy, and most of these reports showed no difference in outcome after 1 year’s follow-up.11,12 As both techniques are commonly used at our center with varying results depending on the patient’s age and the surgical technique used, we wanted to compare retrospectively the degree of improvement in the extension deficits of the affected joints, particularly in the MCP and proximal interphalangeal (PIP) joints.