Mini-Open Partial Fasciotomy for Dupuytren Contracture: Time to Reintervention

Abstract

Background

In younger patients with Dupuytren contracture, recurrence is common over time. Mini-open fasciotomy is a surgical approach that maintains virgin tissue at the palmar digital crease. This study’s primary aim is to determine time to repeat intervention after mini-open partial fasciotomy for Dupuytren contracture and to report the rate of postoperative complications.

Methods

Retrospectively, all patients who underwent minimally invasive open partial fasciotomy for Dupuytren contracture with a pretendinous cord under the care of a single surgeon from 2015 to 2022 were identified. Degree of contracture of the metacarpophalangeal (MP) and proximal interphalangeal (PIP) joints were recorded preoperatively and at each subsequent office visit. Postoperative complications, recurrence of flexion contracture (>20°), and reoperation were recorded.

Results

Twenty-eight patients undergoing procedures on 39 digits with 44 joint contractures were included, consisting of 34 fingers with MP contractures and 5 fingers with both MP and PIP contractures. The median follow-up was 5.0 (interquartile range [IQR] = 3.6-6.9) years. The median preoperative MP contracture was 47.5° (IQR = 35°-62°), which corrected with a median contracture of 15.0° at the final measurement, 2.4 years postoperatively. The median preoperative PIP contracture was 52.5° (IQR = 39°-71°), which corrected with a median 15.0° at the final measurement, 1.5 years postoperatively. Contracture recurrence occurred in 16 (36%) joints (36%) at 3.7 (IQR = 2.7-4.4) years. Younger age (odds ratio [OR] = 0.87, P = .003) and male sex (OR 21.9, P = .014) were independently associated with contracture recurrence. Nine MP joints (20%) underwent reoperation at a median 4.1 (IQR = 3.3-6.0) years.

Conclusions

Mini-open partial fasciotomy for pretendinous Dupuytren contracture represents a safe and effective treatment for MP and PIP joints with only 1 in 5 joints undergoing repeat intervention within 5 years.

Keywords

Dupuytren contracture mini-open partial fasciotomy time to reintervention pretendinous cord

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References

Black

Blazar

PE.

Dupuytren disease: an evolving understanding of an age-old disease. J Am Acad Orthop Surg. 2011;19(12):746-757. doi:10.5435/00124635-201112000-00005

Benson

Williams

Kahle

Dupuytren’s contracture. J Am Acad Orthop Surg. 1998;6(1):24-35. doi:10.5435/00124635-199801000-00003

Hindocha

Stanley

Watson

, et al Dupuytren’s diathesis revisited: evaluation of prognostic indicators for risk of disease recurrence. J Hand Surg Am. 2006;31(10):1626-1634. doi:10.1016/j.jhsa.2006.09.006

Henry

Dupuytren’s disease: current state of the art. Hand. 2014;9(1):1-8. doi:10.1007/s11552-013-9563-0

Bulstrode

Jemec

Smith

PJ.

The complications of Dupuytren’s contracture surgery. J Hand Surg Am. 2005;30(5):1021-1025. doi:10.1016/j.jhsa.2005.05.008

Blake

Poelstra

Andrinopoulou

, et al Return to work and associated costs after treatment for Dupuytren’s disease. Plast Reconstr Surg. 2021;148(3):580-590. doi:10.1097/PRS.0000000000008224

Pess

RA.

Results of needle aponeurotomy for Dupuytren contracture in over 1,000 fingers. J Hand Surg Am. 2012;37(4):651-656. doi:10.1016/j.jhsa.2012.01.029

Selles

Zhou

Kan

, et al Percutaneous aponeurotomy and lipofilling versus limited fasciectomy for Dupuytren’s Contracture: 5-year results from a randomized clinical trial. Plast Reconstr Surg. 2018;142(6):1523-1531. doi:10.1097/PRS.0000000000004982

Mendelaar

NHA

Poelstra

van Nieuwenhoven

, et al Outcome of recurrent surgery in Dupuytren’s Disease: comparison with initial treatment. Plast Reconstr Surg. 2019;144(5):828e-835e. doi:10.1097/PRS.0000000000006150

10.

Gelman

Schlenker

Bachoura

, et al Minimally invasive partial fasciectomy for Dupuytren’s contractures. Hand. 2012;7(4):364-369. doi:10.1007/s11552-012-9461-x

11.

Leafblad

Wagner

Wanderman

, et al Outcomes and direct costs of needle aponeurotomy, collagenase injection, and fasciectomy in the treatment of Dupuytren contracture. J Hand Surg Am. 2019;44(11):919-927. doi:10.1016/j.jhsa.2019.07.017

12.

Chen

Shauver

Chung

KC.

Cost-effectiveness of open partial fasciectomy, needle aponeurotomy, and collagenase injection for dupuytren contracture. J Hand Surg Am. 2011;36(11):1826-1834. doi:10.1016/j.jhsa.2011.08.004

13.

van Rijssen

Werker

PMN.

Percutaneous needle fasciotomy in dupuytren’s disease. J Hand Surg Br. 2006;31(5):498-501. doi:10.1016/j.jhsb.2006.03.174

14.

Morhart

Pearls and pitfalls of needle aponeurotomy in Dupuytren’s disease. Plast Reconstr Surg. 2015;135(3):817-825. doi:10.1097/PRS.0000000000000961

15.

American Society for Surgery of the Hand. Coding APP. Accessed April 28, 2025. https://www.assh.org/s/coding-app

16.

Verheyden

. Early outcomes of a sequential series of 144 patients with Dupuytren’s contracture treated by collagenase injection using an increased dose, multi-cord technique. J Hand Surg Eur Vol. 2015;40(2):133-140. doi:10.1177/1753193414530590

17.

Hurst

Badalamente

Hentz

, et al Injectable collagenase clostridium histolyticum for Dupuytren’s contracture. N Engl J Med. 2009;361(10):968-979. doi:10.1056/NEJMoa0810866

18.

Peimer

Blazar

Coleman

, et al Dupuytren Contracture Recurrence Following Treatment With Collagenase Clostridium Histolyticum (CORDLESS [Collagenase option for reduction of Dupuytren long-term evaluation of safety study]): 5-year data. J Hand Surg Am. 2015;40(8):1597-1605. doi:10.1016/j.jhsa.2015.04.036

19.

Peimer

Blazar

Coleman

, et al Dupuytren Contracture Recurrence Following Treatment with Collagenase Clostridium Histolyticum (CORDLESS Study): 3-year data. J Hand Surg Am. 2013;38(1):12-22. doi:10.1016/j.jhsa.2012.09.028

20.

Atroshi

Nordenskjöld

Lauritzson

, et al Collagenase treatment of Dupuytren’s contracture using a modified injection method: a prospective cohort study of skin tears in 164 hands, including short-term outcome. Acta Orthop. 2015;86(3):310-315. doi:10.3109/17453674.2015.1019782

21.

Peimer

McGoldrick

Kaufman

Nonsurgical treatment of Dupuytren contracture: 3-year safety results using collagenase clostridium histolyticum. J Hand Surg Am. 2013;38(10):e52. doi:10.1016/j.jhsa.2013.08.083

22.

Eberlin

Mudgal

CS.

Complications of treatment for Dupuytren disease. Hand Clin. 2018;34(3):387-394. doi:10.1016/j.hcl.2018.03.007

23.

Eberlin

Kobraei

Nyame

, et al Salvage palmar fasciectomy after initial treatment with collagenase clostridium histolyticum. Plast Reconstr Surg. 2015;135(6):1000e-1006e. doi:10.1097/PRS.0000000000001282

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