SEVERE CONTRACTURES OF THE PROXIMAL INTERPHALANGEAL JOINT IN DUPUYTRENS DISEASE - COMBINED FASCIECTOMY WITH CAPSULOLIGAMENTOUS RELEASE VERSUS FASCIECTOMY ALONE
N. Weinzweig et al., SEVERE CONTRACTURES OF THE PROXIMAL INTERPHALANGEAL JOINT IN DUPUYTRENS DISEASE - COMBINED FASCIECTOMY WITH CAPSULOLIGAMENTOUS RELEASE VERSUS FASCIECTOMY ALONE, Plastic and reconstructive surgery, 97(3), 1996, pp. 560-566
Severe proximal interphalangeal joint contracture in Dupuytren's disea
se presents a frustrating problem for the hand surgeon. Some surgeons
argue for fasciectomy alone, avoiding violation of the proximal interp
halangeal joint, which may prolong morbidity and result in permanent l
imitation of flexion; this loss of flexion can be more disabling than
a mild flexion contracture. Others favor capsulotomy in addition to fa
sciectomy, especially for severe contractures, to obtain additional re
lease, arguing that one cannot completely correct secondary contractur
e by fasciectomy alone. We performed a retrospective review of severe
flexion contractures (60 degrees or greater) involving 42 proximal int
erphalangeal joints in 28 patients with Dupuytren's disease. Twenty-se
ven joints in 18 patients underwent fasciectomy alone, and 15 joints i
n 10 demographically similar patients inderwent capsulotomy in additio
n to fasciectomy. In the noncapsulotomy group, preoperative contractur
e averaged 78.4 degrees. Postoperative contracture averaged 36.6 degre
es, with a 53 percent improvement. In the capsulotomy group, preoperat
ive joint contracture averaged 82.5 degrees. Postoperative contracture
averaged 36.8 degrees, with a 55 percent improvement. Intraoperative
residual contracture for 21 of the 27 joints in the noncapsulotomy gro
up averaged 7 degrees compared with 8 degrees for 9 of the 15 joints i
n the capsulotomy group. Preoperative proximal interphalangeal joint f
lexion averaged 100.6 degrees in the noncapsulotomy group and 98.6 deg
rees in the capsulotomy group. Postoperative flexion averaged 92.2 deg
rees in the noncapsulotomy group, which was 91.7 percent of preoperati
ve flexion, and 82.7 degrees, which was 133.9 percent of preoperative
flexion, in the capsulotomy group. No statistically significant differ
ence was seen in the percentage of contracture correction in the capsu
lotomy group compared with the noncapsulotomy group at follow-up. The
degree of correction initially obtained at surgery using either method
was not maintained during the short follow-up period. There was a sig
nificant decrease in postoperative proximal interphalangeal joint flex
ion compared with preoperative flexion following either surgical appro
ach; however, there was no significant difference between the two grou
ps with respect to the percentage of flexion lost. Complications devel
oped in both groups but tended to occur more commonly in the capsuloto
my group. This study failed to show any advantage to capsuloligamentou
s release in addition to fasciectomy in treating severe proximal inter
phalangeal joint contracture due to Dupuytren's disease.