Outcome of arthrodesis for severe recurrent proximal interphalangeal joint contractures in Dupuytren’s disease

Abstract

We report long-term outcomes of proximal interphalangeal joint arthrodesis for treatment of severe recurrent joint contractures secondary to Dupuytren’s disease. The patients had at least two previous procedures for Dupuytren’s contracture that involved the same joint, before undergoing joint fusion. Patient demographics, satisfaction, functional outcome, complications, revision and re-operation rates are reported. Eleven patients were included with a mean age of 64 years (range 53–73). The mean proximal interphalangeal joint contracture at presentation was 102° (range 80°–120°). None required revision surgery at a mean of 8 years and 9 months (range 9–199 months). All patients were able to perform their activities of daily living and would recommend this operation to family and friends. This series shows that proximal interphalangeal joint arthrodesis combined with needle fasciotomy or segmental fasciectomy provides a satisfactory salvage procedure in cases of severe recurrent Dupuytren’s disease. Level of evidence: IV

Artrodesis de articulación interfalángica proximal en enfermedad de Dupuytren: Una revisión sistemática cualitativa

“…En lo relativo al “grado de satisfacción”, los estudios de Novoa-Parra et al 15 y Bolt et al 17 indicaron que todos los pacientes repetirían y recomendarían esta cirugía. Watson y Lovallo 14 señalaron que todos sus pacientes se mostraron satisfechos.…”

“…In three of the studies, 14,16,17 PIP joint arthrodesis required some adherence release (fasciectomy, PA, release of checkrein deformities) to reduce the flexion contracture to the desired angulation. These procedures have a more limited extent than conventional fasciectomies.…”

“…A potential reoperation enables the correction of unsatisfactory postoperative angulations, as occurred in two subjects in the study by Pillukat et al 16 These characteristics probably account for the high level of patient satisfaction with this procedure. Pillukat et al 16 quantified this satisfaction as 8/10, and Novoa-Parra et al 15 and Bolt et al 17 reported that all their patients would repeat this surgery and recommend it to their families. Watson and Lovallo's 14 patients were satisfied with the intervention.…”

“…La posibilidad de reintervención permite corregir angulaciones posoperatorias insatisfactorias para el paciente, como ocurrió en dos sujetos del estudio de Pillukat et al 16 Estas características son probablemente responsables del alto grado de satisfacción del paciente con este procedimiento. Pillukat et al 16 cuantificaron este parámetro con un 8/10, y Novoa-Parra et al 15 y Bolt et al 17 indicaron que todos sus pacientes repetirían esta cirugía y la recomendarían a sus familiares. Los pacientes de Watson y Lovallo 14 se mostraron satisfechos con la intervención.…”

Wrist & Hand

“…Joint fusion is an option, and this retrospective study from Oxford (UK) assessed the outcomes after proximal interphalangeal joint (PIPJ) fusion. 8 A total of 11 patients were identified over a 17-year period with a median age of 64 years. Dupuytren's disease affected the little finger in ten patients and the ring finger in one; all patients had had a minimum of two operations on the affected finger, with eight having undergone both a fasciectomy and a revision fasciectomy with or without a dermofasciectomy.…”