Dupuytren’s Contracture: Epidemiological Patterns and Results Following Radical Fasciectomy

Abstract

Introduction: Dupuytren’s disease is a debilitating condition, affecting the palmar fascia of the hand. Patients develop a flexion contracture and have difficulties in activities of daily living. Treatment is usually surgical, and a wide range of options are available. Aim: To study the epidemiological parameters associated with Dupuytren’s contracture and to study the results following Radical Fasciectomy. Materials and Methods: This was a prospective, interventional, institutional based study conducted at Dr RML Institute of Medical Sciences. A total of 26 patients with Dupuytren’s disease, fulfilling the inclusion criteria, were treated with radical fasciectomy. Epidemiological parameters and postoperative improvement in form of Digitopalmer Distance (DPD), extension lag and Quick DASH scores were recorded. Data was analysed using SPSS version 21 software. Continuous data was analysed by student's t-test and categorical data was analysed by chisquare test and p-value less than 0.05 was considered as significant. Results: Mean age of involvement in the present study was 54.82±7.34 years. An 84% (22 patients) of patients were male and 16% (4 patients) female. Bilateral hand involvement was seen in 84.61% and single hand involvement was seen in 15.38%. Dominant hand involvement was seen in 69.23% cases, nondominant hand in 15.38% cases and bilateral hands equally in 15.38% cases. Thenar Band and Commissural Band was noticed in 19% of cases. A total of 27% of all cases were diabetics, and 15% were known smokers. One patient in the entire series was a known epileptic on medications. DPD following surgery at two weeks and three months postoperatively was satisfactory as more than 60% of patients had full closure and more than 90% had a DPD of less than two centimeters. Extension Lag at MCP and PIP joints was found to be satisfactory as full opening at both MCP and PIP joints was found in more than 80% patients postoperatively at two weeks and three months. Conclusion: Outcomes following radical fasciectomy are very encouraging in terms of functional results as well as patient satisfaction. Intensive hand therapy during the first two weeks in the postoperative period gives best functional results.

Keywords

• epidemiology
• flexion contracture
• palmer fascia