External Screw-Threaded Traction Device Helps Optimize Finger Joint Mobility in Severe Stage III and IV Dupuytren Disease
Raymund E. Horch, Marweh Schmitz, Maria Kreuzer, Andreas Arkudas, Ingo Ludolph, Wibke Müller-Seubert
Department of Plastic and Hand Surgery, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
Med Sci Monit 2021; 27:e929814
Treating advanced finger joint contractures from Dupuytren disease remains a challenge. We evaluated the effectiveness of a skeletal distraction device versus alternative treatment options.
MATERIAL AND METHODS: We analyzed the surgical treatment of contracted finger joints in stage III and stage IV Dupuytren’s disease over a 10-year period. Data were obtained from inpatient and outpatient medical records, including postoperative clinical examinations and extended Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire scores. Complications of infection, postoperative pain, and wound healing disorders were recorded.
RESULTS: A total of 79 patients (83 hands) were assigned to 2 treatment groups. Patients in group 1 underwent an initial open transection of the main fibrous cord, Z-plasty, distraction with the Erlangen external distraction device, and fasciectomy. The distraction period was 13 to 81 days (mean 31 days). Group 2 underwent a conventional single-stage fasciectomy and arthrolysis. DASH scores and subjective patient satisfaction were lower in group 1 (20.7/33%) than in group 2 (10.3/50%). However, the staged approach of group 1 to treat proximal interphalangeal joint contractures in the long term (improvement >40%) was more effective than the approach of group 2 (>33%). Distraction device pin infections occurred in 20% of hands. Postoperative pain and complex regional pain syndrome type I occurred in 25% of hands in group 1 and 3% in group 2.
CONCLUSIONS: A screw thread driven external fixation device is useful in end-stage Dupuytren’s finger joint contractures. It is indicated when joint contractures are advanced and simple arthrolysis is insufficient.
Keywords: Dupuytren Contracture, External Fixators, Joint Capsule Release