Abstract
Purpose of Study: To assess the efficacy of two-stage correction (skeletal traction followed by Partial Fasciec-tomy) in treating severe Dupuytren’s contractures.
Material, Methods and Results: We retrospectively reviewed sixteen fingers in fifteen patients with severe Dupuytren’s contracture (Tubiana Grade III/IV), operated between April 2000 and July 2005. The mean age was 58 years (27 – 82 years).
All patients underwent an initial application of Orthofix external fixator with pins in the proximal and middle phalanx. The patients were advised to gradually distract the device 3-4 times a day, for two weeks. They were then brought back for removal of fixator and partial fasciectomy with closure of skin by V-Y plasty.
The results were assessed in thirteen patients, as two were lost to follow-up. The mean follow-up period was 30 months (6 – 64 months). The total mean preopera-tive extension deficit improved from 130 degrees to 38 degrees postop.; PIP joint deformity improved from a mean of 77 degrees to 33 degrees postop. and the mean TRAM (Total range of active movements) improved from 108 degrees to 165 degrees.
Functional assessment was done using Michigan Hand Outcome Questionnaire. Overall improvement in hand function was from a preoperative 34% to a postoperative 89%.; aesthetic improvement from a preop. of 46% to a postop of 81% and pain improvement from a preop of 66% to a postop of 96%.
One patient had recurrence, one had features of RSD (Reflex Sympathetic Dystrophy) and one had to undergo amputation due to poor tolerance and persistent infection.
Conclusion: Severe Dupuytren’s contracture is a challenging deformity to deal. The two-stage correction may be considered as an alternative method of treatment in cooperative patients. Our study has shown promising results with good patient satisfaction
Correspondence should be addressed to Mr Bimal Singh, BOSA at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE
