SEVERE CONTRACTURES OF THE PROXIMAL INTERPHALANGEAL JOINT IN DUPUYTRENS DISEASE - COMBINED FASCIECTOMY WITH CAPSULOLIGAMENTOUS RELEASE VERSUS FASCIECTOMY ALONE

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.