From the Research
Surgery is the most effective treatment option for Dupuytren contracture, particularly for severe contractures, as it provides the most definitive correction and has superior success rates compared to needle fasciotomy and collagenase injection at 2 years, as shown in a recent randomized controlled trial 1.
Treatment Options
The treatment of Dupuytren contracture depends on the severity of the disease and the presence of functional limitations. The primary options for treatment include:
- Needle aponeurotomy (percutaneous needle fasciotomy)
- Collagenase injections (Xiaflex/collagenase clostridium histolyticum)
- Surgical fasciectomy
Comparison of Treatment Options
A recent study compared the effectiveness of surgery, needle fasciotomy, and collagenase injection for Dupuytren contracture, and found that surgery had superior success rates at 2 years compared to both needle fasciotomy and collagenase injection 1. Another study found that percutaneous needle fasciotomy tended to provide higher patient satisfaction with fewer adverse events, but had a higher rate of recurrence compared to limited fasciectomy 2.
Considerations for Treatment Selection
Treatment selection should consider the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joint involvement, as PIP contractures are more difficult to correct and prone to recurrence. Physical therapy, including stretching exercises and night splinting for 3-6 months, is important after any intervention.
Evidence Summary
The evidence suggests that surgery is the most effective treatment option for Dupuytren contracture, particularly for severe contractures, due to its superior success rates and definitive correction. However, the choice of treatment should be individualized based on disease severity, patient preferences, and potential risks and benefits. A recent systematic review and economic evaluation found that limited fasciectomy was the most cost-effective choice to treat moderate to severe contractures, whereas collagenase was not 3.