Dupuytren's contracture is a common condition affecting 25% of men over the age of 65. With less advanced disease or with patients not suitable for a general or regional anaesthetic needle fasciotomy is the surgical option of choice. The aim of this audit is to see whether the Department of Trauma and Orthopaedic surgery at Wirral University Teaching Hospital NHS Foundation Trust comply with the NICE guidelines. All patients who underwent needle fasciotomy for Dupuytren's contracture at Wirral University Teaching Hospital NHS Foundation Trust from December 2008 and November 2010 were identified. The case notes of these patients were reviewed. In a 23 month period 9 patients (13 fingers), underwent needle fasciotomy. There were 6 female and 3 male patients. The mean age at the time of surgery was 70 years (61-84 years). Of the 13 MCPJ contractures 12 had a full correction. At the PIPJ 5 of the 8 had a full correction. Of the one contracture affecting the DIPJ, this was fully corrected. None of the patients undergoing needle fasciotomy had any complications recorded. At a minimum follow up 4 months and a mean follow up of 14 months, none of our patients have returned to the unit with recurrence of disease. In our unit needle fasciotomy is a safe and effective in correcting deformity. To date we have no complications or recurrence. None of these patients have returned for further surgery. We are compliant with the NICE guidelines

Introduction. An educated public are becoming increasingly aware of percutaneous needle fasciotomy (PNF) for the treatment of Dupuytren's contracture. We believe that it has an important place in the management of this condition and have set up a dedicated one-stop clinic to perform this procedure. Methods. A prospective study of 61 patients with Dupuytren's, who have undergone PNF have been recruited so far. The study population includes 50 men and 11 women. The average age is 65. The senior author has operated on 81 fingers including 69 MCP joints, 62 PIP joints and 6 DIP joints. We recorded contractures prior to PNF and immediately following the procedure, as well as any complications. At follow up we recorded the Patient global impression of change (PGIC), DASH scores, degree of straightness of the operated finger and whether they would have the procedure again or recommend it. Results. For MCP joints the average pre treatment contracture was 43. o. and immediately post operatively it was 3. o. For PIP joints the average pre treatment contracture was 48. o. and immediately post operatively it was 17. o. For DIP joints the average pre treatment contracture was 41. o. and immediately post operatively it was 20. o. 8 patients had small skin tears and 2 found it too uncomfortable to continue. No nerve or tendon injuries. Mean follow up was 9 months (6–24). At follow up the average PGIC was 6 (very good) and the average DASH score was 30.9 (excellent). Subjectively the vast majority of fingers remained straight. All but 4 patients would have the procedure again and would recommend it to others. Discussion. This specialist clinic offers a very effective, safe procedure and our patients are highly satisfied withthe results. It is also cost effective for our Department

Introduction. Evaluating the success of a treatment has changed. Currently, the emphasis is on patient-rated outcome scores rather than surgeon recording of outcome measures. Functional outcome and patient satisfaction following Dupuytren's disease surgery is poorly quantified in the literature. This study aimed to assess subjective patient hand function, disability and satisfaction using a PEM score and its correlation with residual contracture. Methods. Percutaneous Needle Fasciotomy (PNF) is performed in our outpatient clinic to treat Dupuytren's contracture at MCP joints. A validated patient completed questionnaire (PEM) was used to record patient demographics, side of surgery, finger involved, time since surgery, residual symptoms, disability, subjective hand function and satisfaction. The questionnaire was posted to all patients who had PNF over the study period (n=68) along with a stamped addressed envelope and participant information sheet. Results. 68 patients had PNF surgery on 73 hands. Completed questionnaires were returned from 46 patients (51 hands), a response rate of 70%. Mean follow-up was 15 months (SD +/− 10), range 5-36 months. Wilcoxon Signed Ranks Test showed that change in ‘function of hand’ over time was statistically significant (z = 5.82, n-ties = 50, p < 0.001). Spearman's test showed a significant correlation between any residual contracture and total score on the PEM (r. s. = 0.540, N=51, p <0 .001, two tailed). Multiple linear regression revealed that the correction achieved at time of surgery was a significant predictor of subjective hand function (p= 0.001). Most of the patients were satisfied with their surgery and its outcome, a cumulative mean score of 4.80 with SD +- 2.58. Conclusion. Significant improvement in contracture and deformity and good patient satisfaction can be achieved by percutaneous needle fasciotomy. Hand function measured using this tool (PEM Score) was strongly correlated with final deformity at follow-up

Dupuytrens disease is a fibrosing condition of the palmar aponeurosis and its extensions within the digits. Normal fascial fibres running longitudinally in the subcutaneous tissues of the palm become thickened and form the characteristic nodules and cords pathognomonic of Dupuytrens disease. A wide variety of surgical interventions exist, of these the partial fasciectomy remains the most conventional and widely used technique. Minimally invasive surgical treatments such as needle fasciotomy are, however, becoming increasingly popular. Dupuytrens disease remains a challenging condition to treat as recurrence is universally found with all surgical interventions. Although recurrence may be related to the severity of the disease, there are currently no research tools other than clinical examination to examine changes in the diseased tissue postoperatively and predict likelihood of long-term success. Magnetic Resonance Imaging (MRI) may be of value for the study of Dupuytren disease, at present its use has been greatly underexplored. We wished to carry out a pilot study in order to examine the possibility of using 3.0 Tesla MRI to study Dupuytren tissue and then furthermore to examine the potential changes post-operatively following percutaneous fasciotomy. Five patients set to undergo percutaneous needle fasciotomy were recruited and consented for the study. All patients underwent MRI scanning of the affected hand pre-operatively and at two weeks post-operatively. Scanning was carried out in the 3.0 Tesla research MRI scanner at Aberdeen Royal Infirmary. Patients were placed prone in the MRI scanner with the hand outstretched above the head in the so-called “Superman” position. A specially designed wrist and hand coil was used. Under the expertise of radiographers and physicists, image capture encompassed four novel scanning sequences in order to make a volumetric three-dimensional image sample of the affected hand. MIPAV software (Bethesda, Maryland) was used for image analysis. Scanning revealed well defined anatomy. The Dupuytren cord arose from the palmar aponeurosis tissue which is deep to the palmar skin and subcutaneous tissue. It was distinctly different to deep structures such as the flexor tendons and intrinsic hand muscles which appeared with a uniform low and high signal respectively. The Dupuytren tissue had a heterogeneous signal on both T1 and T2 images. On T1 the tissue signal appeared high to intermediate, similar to that of bone and muscle, but low areas of signal were observed diffusely in an irregular fashion throughout. On T2 the tissue had a low signal throughout with some focal areas of high signal. Dupuytren tissue was mapped using MIPAV software for pre- and post-operative comparisons. Signal intensity, surface area and volume of the cords and fasciotomy sites were explored. Our initial results suggest MRI can be used to study Dupuytren tissue. Such a research tool may be of use to study the natural history of Dupuytren disease and furthermore, the response to medical and surgical interventions