Dupuytren’s Contracture

Dupuytren’s Contracture —

— It’s a proliferative proliferation of Palmar Tissue and fascia along with palmo digital extension. This results in formation of modules and cords which further develop in secondary flexion deformities of fingers.

— Male : Female = 10:1

— Risk Factors = Diabetes , Alcohol , Epilepsy , Liver Disease , cigarette smoking

— Order of Involvement = Ring Finger > Little Finger > Middle Finger > Index Finger > Thumb

— Associations =

Ledderhose Disease ( Lesions in Plantar Fascia )

Peyronie’s Disease ( Plastic induration of penis )

— There is myofibroblastic proliferation and deposition of type III collagen.

— For a static Disease with no / minimal contracture = Observation

— If flexion deformity > 30 degrees at MCPJ and > 15 degrees at PIPJ = Surgery

— Surgical Options –

Percutaneous Fasciectomy

Fasciectomy ( most widely done )

Segmental Aponeurectomy

DermoFasciectomy

Amputations were done at one point of time

— Complications of Surgery

NeuroVascular Injury , Hematoma , Recurrence , Infection , Stiffness , Reflex Sympathetic Dystrophy

– InOperable Cases are given trials of CCb’s , Steroid injections with Hyaluronidase / Collagenase / Trypsin