Dupuytren's disease: limited fasciectomy, night splinting, and hand exercises-long-term results.

BACKGROUND

Dupuytren's contracture (DC) is a fibroproliferative disorder of palmar fascia that causes flexion contractures of one or more digits. There is currently no gold standard operative and postoperative protocol for reducing recurrence rates. We propose a combination of surgical intervention, night splinting, and home hand exercises as a treatment protocol.

METHODS

Thirty patients were included in our study, diagnosed with DC Tubiana grade II-IV. Our treatment protocol was limited fasciectomy followed by a 24-week night splint application, combined with home hand exercises for eight weeks. The outcomes were recurrence, QuickDASH score, extension or flexion deficit, and grip strength. The mean follow-up was 4.9 years (range 2-11 years).

RESULTS

Recurrence of DC occurred in two patients (7%), who had discontinued the use of the splint within two months postoperatively. All other patients had complied with the postoperative protocol. The mean QuickDASH score improved from 61.5 (SD 2.1) to 8.6 (SD 2) postoperatively (p < 0.001). Grip strength did not differ significantly in the operated hands (37.9 kg, SD 1.3) when compared to the healthy hands (40.2 kg, SD 1.3, p = 0.035). The recurrence was not significantly correlated either with the Tubiana grade (p = 0.7), or with the patients' age (p = 0.27).

CONCLUSIONS

This study shows that limited fasciectomy followed by a 24-week night splint application, combined with home hand exercises for at least eight weeks, is a viable protocol which reduces the rates of recurrence of DC.