From the Guidelines
Dupuytren's contracture is a clinical sign suggestive of harmful alcohol consumption or liver cirrhosis, and patients presenting with this condition should be screened for alcohol-related liver disease (ALD) and undergo brief intervention and referral to a multidisciplinary team if necessary. This condition is characterized by a progressive thickening of tissue under the palm skin, causing fingers to bend inward toward the palm, making it difficult to fully extend them [no reference provided as this is general medical knowledge]. The management of Dupuytren's contracture itself is not directly addressed in the provided evidence, but it is essential to consider the potential underlying causes, such as harmful alcohol consumption, and to screen for ALD in patients with this condition, as recommended by the guidelines 1. Some key points to consider in the management of patients with Dupuytren's contracture include:
- Screening for harmful alcohol consumption should be done systematically in patients with clinical signs suggestive of ALD, including Dupuytren's contracture 1
- Brief intervention and referral to a multidisciplinary team should be considered for patients identified through screening 1
- Reducing alcohol consumption is crucial in reducing the risks of disease progression and occurrence of complications from cirrhosis 1
- Public health policies, such as price-based policies and regulation of availability, can be effective in reducing ALD-related morbidity and mortality 1
From the Research
Definition and Treatment Options
- Dupuytren's contracture is a benign condition characterized by fibrosis of the palmar and digital fascia, which may be debilitating and limit daily function 2.
- Treatment options for Dupuytren's contracture include percutaneous needle fasciotomy (PNF), collagenase Clostridium histolyticum (CCH) injection, open fasciotomy, fasciectomy, dermofasciectomy, and amputation in severe cases 3, 2.
Percutaneous Needle Fasciotomy (PNF)
- PNF is a minimally invasive treatment option for mild to moderate Dupuytren contractures in the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints 3.
- PNF can be performed in a regular outpatient clinic, requires limited resources, and has a minimum of rehabilitation compared to limited fasciectomy 3.
- Multiple contractures can be treated during the same session, and the treatment is considerably easier for the patient 3.
Collagenase Clostridium Histolyticum (CCH) Injection
- CCH injection is a minimally invasive treatment option that enables rupture of the cord similar to PNF 3.
- CCH treatment is considerably more expensive than PNF and requires 2 visits by the patient to the outpatient clinic instead of 1 3.
- CCH has also been reported to have more complications than PNF, including local pain, edema, ecchymosis, lymphadenopathy, and pruritis 3, 4.
Comparison of PNF and CCH
- Some studies suggest that PNF may have superior clinical outcomes compared to CCH, with a higher minor complication rate with CCH 4, 5.
- However, other studies have demonstrated no significant differences in outcomes between the two techniques 5.
- A systematic review of comparative studies found that PNF and CCH have similar intermediate-term outcomes, but PNF may have a higher success rate in terms of contracture improvement and patient satisfaction 4.