Dupuytren’s Contracture

Abstract

Dupuytren's contracture, a benign condition characterized by fibrosis of the palmar and digital fascia, may be a debilitating condition that limits daily function. Several techniques exist for managing symptomatic contractures of the hand related to Dupuytren's. These techniques include the more invasive open fasciotomy or fasciectomy. More recently, less invasive techniques including administration of collagenase Clostridium histolyticum (CCH) or percutaneous needle aponeurotomy (PNA) have become part of the treatment armamentarium. A comprehensive review of the literature is performed and an algorithm for management of Dupuytren's contracture is proposed.

Ledderhose Disease With Concomitant Presence of Dupuytren Contracture: A Case Report and Review of the Literature

“…The palmar fascia of Dupuytren patients is defined by myofibroblast influx and concentration of type III collagen, leading to cord formation and contracture. 5 Unlike Dupuytren disease, however, contracture in Ledderhose seems to be rare. This is attributed to the anatomic nature of the plantar fascia which is divided by thinner and more insignificant longitudinal slips than those of the palmar fascia, thereby avoiding the flexion deformity of the toes.…”

“…16 Mella et al have formulated a simplified treatment algorithm incorporating patient-, disease-, and intervention-related factors. 5 If a patient develops recurrence less than 1 year from a nonsurgical treatment, the algorithm suggests the patient would benefit from an operative approach. In cases of aggressive recurrence or inhibition of daily activities, surgical treatment is indicated.…”

“…As with Dupuytren disease, a treatment algorithm that factors disease severity, patient preference, and concern for recurrence should be utilized in the management of Ledderhose disease. 5 We present a case in which both diseases occurred concomitantly and the patient achieved symptomatic relief with surgical intervention.…”

“…2 Current theory suggests the pathology may be a compensatory response to mechanical forces. 5 Ledderhose disease has an estimated incidence of 1 to 2 per 100 000 and is more common in males. 6 It is often associated with Dupuytren disease of the hand and Peyronie disease of the penis.…”

“…8 Diabetes mellitus, liver disease, alcohol abuse, epilepsy, and repeated trauma have all been frequently described in association with development of lesions in all 3 conditions. 1,5,9,10 Ledderhose and Dupuytren diseases have shown the highest association, ranging from 2% to 25% concomitance rate. 3,6,9,11 One of the most challenging aspects of treatment in both Ledderhose and Dupuytren disease is symptom recurrence described by either continuous pain or failure of conservative measures.…”