PURPOSE:Dupuytren's disease (DD) is one of the most common disorders of the hand, affecting 5.7-11.7% of the global population. This study seeks to evaluate the longterm efficacy of the two most prominent treatment modalities, injectable collagenase Clostridium histolyticum versus open fasciectomy. We hypothesize that those who had an open fasciectomy to treat their contracture will have significantly less recurrence, greater degree of deformity improvement, and fewer procedural interventions in the long-term. METHODS:We conducted a retrospective review of all electronic medical records of patients who underwent open fasciectomy or collagenase injection to treat their persistent Dupuytren's contracture between April 2011 and April 2021. All procedures were performed by one of five senior surgeons at the same Veterans Affairs Hospital hand surgical center. Therapeutic administration and documentation for both fasciectomy and collagenase injection patients were managed by a single licensed hand therapist.

Statistically significant findings were observed with respect to reduction in pain in both groups as well as improvement in wrist flexion in the pyrocarbon group. Post-operative complications warranting surgical intervention occurred in 10 patients. Of these ten were 2 in the ulnar head implant group; pain and reduced range of motion necessitated one revision to an Aptis implant and one revision to a pyrocarbon implant. In the Pyrocarbon group, 8 surgical interventions were required: 3 pinning in supination for reduced range of motion, 1 exchange with a smaller size implant due to pain, 1 addition of meniscal allografting for pain, and three conversions to Aptis implants for pain and instability.CONCLUSIONS: Painful DRUJs in young patients warrant a surgical intervention which preserves stability and provides longevity with possibility for revision during their lifetime. Hemiarthroplasty allows for preservation of stability, seen in 33/34 patients in this study, with improved symptom management which was seen in 29/34 patients. This study found equal efficacy of the standard ulnar head implant to that of the off-label use of the MCP Pyrocarbon implant. However, the osteointegration of the partial ulnar head implant means future revision would have increased risk of complication. As well, the metallic head of the partial ulnar head implant is known to cause osteolysis of the radial fossa making it less ideal for young patients with future decades of implant wear. Due to these limitations and the similar efficacy, we recommend the use of this prothesis in young patients with symptomatic DRUJ.

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