Abstract
Objective
To assess patterns of recurrence in patients with Dupuytren's disease after surgery for proximal interphalangeal joint (PIPJ) deformity.
Methods
81 patients (94 fingers) with Duputyren's contracture of the proximal interphalangeal joint underwent surgery to have either a ‘firebreak’ skin graft (46 fingers) or a fasciectomy (48 fingers). They were reviewed after three weeks, six weeks, 6, 12, 24 and 36 months to note the range of movement and recurrence. Both groups were similar with regard to age, gender and factors considered to influence the outcome such as bilateral disease, family history, and the presence of diabetes, smoking and alcohol intake.
Results
The rate of recurrent contracture of PIP joint was 12.2%. Four patterns were identified: Group 1 (Responsive group: Immediate improvement, maintained over three years), Group 2 (Improved group: Initial mild loss of position but improvement maintained), Group 3 (Stiffness group: Immediate significant worsening but maintained), and Group 4 (Recurred group: Immediate loss of position with further progressive contracture). Time since onset of Dupuytren's disease and pre-op PEM showed significant association with recurrent contracture on regression analysis (GEE, Wald chi square test, P< 0.01)
Conclusion
Four distinct patterns of recurrent contracture of PIP joint were identified three years after corrective surgery for Dupuytren's disease. Pre-operative PEM and disease duration could predict recurrence.
