From the Guidelines
Dupuytren's contracture affecting the middle finger MCP joint should be treated with collagenase injections (Xiaflex) as the first line of treatment, considering its efficacy and safety profile, as well as the importance of preserving hand function and quality of life. When considering treatment options for Dupuytren's contracture, it is essential to prioritize approaches that minimize morbidity, mortality, and impact on quality of life. The provided evidence, although focused on hand osteoarthritis, highlights the importance of individualized treatment plans, considering factors such as the severity of the condition, patient age, and comorbidities 1. In the context of Dupuytren's contracture, treatment choices include:
- Observation for mild cases
- Needle aponeurotomy (percutaneous needle fasciotomy) for moderate cases
- Collagenase injections (Xiaflex) for more severe contractures
- Surgical fasciectomy as a last resort for advanced disease Post-treatment care, including splinting and physical therapy, is crucial for maintaining range of motion and preventing recurrence. Given the potential for recurrence and the importance of preserving hand function, treatment decisions should be made on a case-by-case basis, taking into account the patient's overall health, preferences, and lifestyle. While the provided evidence does not directly address Dupuytren's contracture, the principles of individualized treatment and prioritizing quality of life are applicable to this condition as well 1.
From the Research
Treatment Options for Dupuytren's Contracture Affecting the Middle Finger MCP Joint
- Collagenase injection and surgical fasciectomy are two treatment options for Dupuytren's contracture, with varying degrees of success in improving finger joint contracture 2.
- A study comparing collagenase injection with surgical fasciectomy found that both treatments improved finger joint contracture, but had a high prevalence of joint contracture in the treated fingers 5 years after treatment 2.
- The degree of PIP joint contracture is related to the outcome of surgical treatment of Dupuytren's disease, with optimal results achieved when contracture degree is between 15° and 30° 3.
- Surgical treatment of MCP joint contracture is successful regardless of the preoperative joint contracture degree 3.
- Percutaneous needle aponeurotomy (PNA) combined with triamcinolone acetonide (TA) injections has been shown to be effective in treating Dupuytren's contracture, with a significantly greater degree of correction of flexion deformity at 6 months compared to PNA alone 4.
Considerations for Treatment
- The choice of treatment for Dupuytren's contracture affecting the middle finger MCP joint should be based on the individual patient's condition and the degree of contracture 3, 5.
- A comprehensive review of the literature suggests that several techniques exist for managing symptomatic contractures of the hand related to Dupuytren's, including open fasciotomy or fasciectomy, collagenase Clostridium histolyticum (CCH), and percutaneous needle aponeurotomy (PNA) 5.
- A systematic review of randomized controlled trials found that PNA tended to provide higher patient satisfaction with fewer adverse events, but had a higher rate of recurrence compared with limited fasciectomy, while treatment with CCH had notable recurrence rates and a high rate of transient adverse events 6.