Treatment of Dupuytren's Disease of the Proximal Interphalangeal Joint: A Systematic Review and Network Meta-analysis.

BACKGROUND

Postoperative outcomes for Dupuytren's disease (DD) of the proximal interphalangeal joint (PIPJ) are highly variable, and the condition often proves refractory to correction. The aim of this study was to summarize the best available evidence on the treatments for DD of the PIPJ.

METHODS

A systematic review and network meta-analysis were conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Medline, Cumulated Index in Nursing and Allied Health Literature (CINAHL), Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science were searched for randomized controlled trials (RCTs) comparing treatments for DD of the PIPJ in adults.

RESULTS

A total of 19 RCTs were included in this study. Based on network meta-analysis of operative techniques, limited fasciectomy resulted in significantly lower total passive extension deficit compared with collagenase injections and percutaneous needle fasciotomy in the short (1-12 weeks) and long term (>2 years). Limited fasciectomy also had the lowest rates of recurrence in the long term when compared with percutaneous needle fasciotomy and collagenase injection. Collagenase injections led to significant clinical improvement compared with placebo. Triamcinolone injections in conjunction with needle fasciotomy were more effective in correcting contracture than needle fasciotomy alone. Postoperative splinting, timing of manual manipulation after collagenase injections, use of dermofasciectomy, and incision type for limited fasciectomy had no impact on correction or recurrence of DD of the PIPJ.

CONCLUSIONS

While DD of the PIPJ is often refractory, limited fasciectomy provides better and more long-lasting contracture correction compared with collagenase injections or needle fasciotomy. More RCTs are needed to effectively compare treatment techniques for this condition.