Management of severe Dupuytren’s contracture of the proximal interphalangeal joint with use of a central slip facilitation device

Abstract

Thirty-eight fingers in 27 patients with Dupuytren's contracture of the proximal interphalangeal joint (PIPJ) in excess of 70° were treated using a staged technique. The first stage involved applying a mini external fixator across the PIPJ for continuous extension over 6 weeks with intensive hand therapy to maintain mobility of the joint and help correct the deformity. Twice weekly during hand therapy sessions the tension of the elastic band across the mini ex-fix was increased, allowing that full active flexion of the PIPJ against the elastic band could still be achieved. The second stage, 4 weeks after the external fixator was applied, involved an open palm technique of fasciectomy for the contracted cords restricting metacarpophalangeal joint movement and dermofasciectomy with full-thickness skin grafting over the proximal phalanx for bands restricting PIPJ movement. The external fixator was used to maintain active extension force until the graft healed. It was generally removed in the outpatient clinic under ring block 2 weeks after the second stage procedure. The patients were followed for a mean of 20.6 (6-48) months. The mean preoperative PIPJ deformity improved from 75° to 37° postoperatively. Overall, 69% of results were rated as good to excellent. Only one patient reported any on-going functional problems. There were eight cases of pin site infections and one case each of loose pins, osteoarthritics at the PIPJ, reflex sympathetic dystrophy, and disease recurrence needing PIPJ fusion. We conclude that our simple staged procedure is a valid alternative in the management of severe Dupuytren's PIPJ contracture.

Experiences with pins and rubber band traction in the treatment of proximal interphalangeal joint contracture

“…All patients achieved full correction of the deformity over a short period of time, even in patients with recurrent Dupuytren disease. It is 'low tech', does not require bulky and expensive external fixators, and can be applied without fluoroscopic guidance or regional anesthesia, unlike some other methods described (3)(4)(5)7). We believe that this modification offers the advantages of the method described by White et al (7), while being easier and less resource intensive that the original description.…”

“…White et al (7) described an additional method for correcting these deformities, and we use a modification of this method. In their published study, two mini-external fixators are applied under fluoroscopic guidance to the dorsum of the middle and proximal phalanges, and elastic (rubber) bands are passed between these two constructs.…”

“…Various regimens have been described including static splinting (2), dynamic splinting (3)(4)(5) or a combination of the two (6). We describe our experience of using a modification of pins and rubber band traction (PRBT) -a method of applying a dynamic extension apparatus to a contracted PIPJ that makes use of the constant traction force in a stretched rubber (elastic) band as described by White et al (7), and report our results in the treatment of contracted PIPJs in the hand. We believe that the PRBT method of PIPJ distraction offers a simple and cost-effective way to treat this condition, and describe some simple modifications to the technique.…”

Dupuytren’s disease: overview of a common connective tissue disease with a focus on emerging treatment options

“…An external fixator is a technique that has been proposed as a potential method of correcting PIP flexion contractures and can be used either before or after the formal Dupuytren's surgery [101].…”

Current concepts in Dupuytren’s disease

“…Eleven therapeutic single cohort studies were identified, but are not discussed further in this article. Most of these concerned techniques on which data has been previously published such as needle fasciotomy and external fixator devices [9][10][11], although there are also some novel techniques such as lipofilling in needle fasciotomy [12]. However, without comparison with a control group these more novel techniques should be considered preliminary in nature.…”