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

Reconfiguration of elective orthopaedic surgery presents challenges and opportunities to develop outpatient pathways to reduce surgical waiting times. Dupuytren's disease (DD) is a benign progressive fibroproliferative disorder of the fascia in the hand, which can be disabling. Percutaneous-needle-fasciotomy (PNF) can be performed successfully in the outpatient clinic.

The Aberdeen hand-service has over 10 years' experience running dedicated PNF clinics. NHS Grampian covers a vast area of Scotland receiving over 11749 referrals to the orthopaedic unit yearly. 250 patients undergone PNF in the outpatient department annually. 100 patients who underwent PNF in outpatients (Jan2019–Jan2020).

79M, 21F. Average age 66 years range (29–87). 95 patients were right hand dominant. DD risk factors: 6 patients were diabetic, 2 epileptic, 87 patients drank alcohol. 76 patients had a family history of DD. Disease severity, single digit 20 patients, one hand multiple digits in 15 patients, bilateral hands in 65 patients of which 5 suffered form ectopic manifestation suggestive of Dupuytren's diasthesis. Using Tubiana Total flexion deformity score pre and post fasciotomy. Type 1 total flexion deformity (TFD) between 0–45 degrees pre PNF n=60 post N= 85, Type 2 TFD 45–90 degrees pre PNF n=18 post N=9, Type 3 TFD 90–135 pre PNF n=15 post N= 5, Type 4 TFD >135 pre PNF n=1 post PNF N=1. Using Chi-square statistical test, a significant difference was found at the p<0.05 between the pre and post PNF TFD. Complication: 8 recurrence, 1 skin tear. No patients sustained digital nerve injury.

Outpatients PNF clinics are a valuable resource.

Aims

To estimate the potential cost-effectiveness of adalimumab compared with standard care alone for the treatment of early-stage Dupuytren’s disease (DD) and the value of further research from an NHS perspective.

Aims. The aim of this meta-analysis was to assess the safety and efficacy of collagenase clostridium histolyticum compared with fasciectomy and percutaneous needle fasciotomy (PNF) for Dupuytren’s disease. Materials and Methods. We systematically searched PubMed, EMBASE, LILACS, Web of Science, Cochrane, Teseo and the ClinicalTrials.gov registry for clinical trials and cohort or case-control studies which compared the clinical outcomes and adverse effects of collagenase with those of fasciectomy or PNF. Of 1345 articles retrieved, ten were selected. They described the outcomes of 425 patients treated with collagenase and 418 treated by fasciectomy or PNF. Complications were assessed using inverse-variance weighted odds ratios (ORs). Clinical efficacy was assessed by differences between the means for movement of the joint before and after treatment. Dose adjustment was applied in all cases. Results. Random-effects modelling showed that patients treated with collagenase had 3.24 increased odds of adverse effects compared with those treated by fasciectomy (OR 4.39) or PNF (OR 1.72,). The effect was lost when only major complications were assessed. Joint movement analysis revealed a difference between means of less than 10%, indicating equivalent clinical efficacy in the short and medium term for collagenase and fasciectomy. We were unable to analyse this for PNF due to a shortage of data. Conclusion. There were no significant differences in effect size between collagenase and fasciectomy. The use of collagenase was associated with a higher overall risk of adverse effects than both fasciectomy and PNF. Cite this article: Bone Joint J 2018;100-B:73–80

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

Aims

In the UK, fasciectomy for Dupuytren’s contracture is generally performed under general or regional anaesthetic, with an arm tourniquet and in a hospital setting. We have changed our practice to use local anaesthetic with adrenaline, no arm tourniquet, and perform the surgery in a community setting. We present the outcome of a consecutive series of 30 patients.

The February 2014 Wrist & Hand Roundup³⁶⁰ looks at: simple debridement and ulnar-sided wrist pain; needle fasciotomy or collagenase injection; joint replacement in osteoarthritic knuckles; the Mannerfelt arthrodesis; scaphoid union rates with conservative treatment; the benefits of atorvastatin for muscle re-innervation after sciatic nerve transection; and complications of trapeziectomy.