Outcomes at two years favoured surgery over collagenase injections and needle fasciotomy.

Patients who need treatment for progressive Dupuytren contracture generally have three options – surgery, needle fasciotomy or collagenase injection. These interventions were compared in a randomised trial that involved 302 Finnish patients.

At baseline, the mean contracture angles at the metacarpophalangeal and proximal interphalangeal joints were 38 and 27 degrees, respectively. Treatment success was defined as 50% or more improvement in the contracture angles, plus a ‘yes’ answer to the question, ‘Would you be satisfied with this outcome and not want to have further treatment if the functional impairment caused by the contracture would remain the same as it is today?’

At three months, about 70% of each group met criteria for success. However, at two years, success was significantly more frequent in the surgery group than in the other two groups (78% vs 65% with collagenase and 50% with needle fasciotomy). Surgery patients also were more likely than collagenase and needle-fasciotomy patients to report that symptoms were ‘much better,’ and slightly more likely to have no residual contracture (44% vs 35% and 25%). 

Comment: In this trial, short-term findings were comparable, whereas outcomes at two years favoured surgery. However, the superiority of surgery was not so dramatic that the two percutaneous options should be considered unreasonable. Rather, patients can be guided by factors such as convenience, cost, potential adverse effects and local availability of clinicians who are experienced with these procedures.

Allan S. Brett, MD, Clinical Professor of Medicine, University of Colorado School of Medicine, Aurora, USA.

Räisänen MP, et al. Surgery, needle fasciotomy, or collagenase injection for Dupuytren contracture: a randomized controlled trial. Ann Intern Med 2024 Feb 13; e-pub (https://doi.org/10.7326/M23-1485).

This summary is taken from the following Journal Watch titles: General Medicine, Ambulatory Medicine.