Dupuytren's disease: analysis of 110 patients on a long-term follow-up

Abstract

The analysis of the surgical therapy results of 110 patients suffering from Dupuytren's disease with an average follow-up of seven years is presented. This was done using the Tubiana staging system, the basis of which is carefully explained in the paper. By determining the recurrence rate (46.4%) and the extension rate (19.2%) in 125 operated hands, the importance and the gravity of recurrence in each of the 292 hand rays is emphasized. The influence on recurrence and extension of factors usually associated with Dupuytren's disease and the relationship between the severity of the initial stages of the disease and recurrence was studied. It was concluded that early surgical intervention, especially in patients under 50 years of age or presenting with ectopic deposits, is effective in lessening the frequency of recurrence.

What are we measuring? A critique of range of motion methods currently in use for Dupuytren’s disease and recommendations for practice

“…Hyperextension was included in 11 of the studies [ 11 , 33 , 50 , 53 , 66 , 72 , 75 , 77 , 80 , 83 , 89 ]. The description of how this was recorded and analysed varied between studies.…”

“…Hyperextension measurement was included in results in four studies [ 11 , 66 , 77 , 83 ] without prior description in the text or discussion on how hyperextension was analysed. Three studies [ 72 , 75 , 89 ] indicated that hyperextension was included in a composite ROM measure with only one [ 75 ] stating how hyperextension was calculated within the composite measure. One publication clearly described how hyperextension was recorded and analysed as a zero value [ 53 ].…”

“…Tubiana grading system assigns a score to the extension deficit of a digit by summing the total deficit angles of the MCP, PIP and distal interphalangeal (DIP) [ 101 , 102 ]. Tubiana grading system was reported both pre and post operatively in 7 studies [ 19 , 50 , 55 , 65 , 72 , 86 , 93 ]. One study [ 50 ] used Tubiana in addition to another ROM measure, the remaining 6 studies [ 19 , 55 , 65 , 72 , 86 , 93 ] used it as their sole measure.…”

“…As previously discussed including hyper extension in a composite calculation raises issues with analysis. It is unclear from the 7 studies [ 50 , 55 , 65 , 72 , 86 , 93 ] how hyperextension was addressed. Additionally this is compounded with Tubiana [ 102 ] stating that the degree of hyperextension at the DIP joint is added to the total flexion deformity (i.e.…”

“…45 degrees at the top of stage 1 or bottom of stage 2 and 90 degrees in stage 2 or 3). The ROM bands for the Tubiana stages are clearly stated in 3 studies [ 55 , 72 , 86 ], however the authors do not state how they dealt with calculations that could be assigned to either stage. Improvement of ROM may occur within a band yet the measure lacks sensitivity to illustrate such.…”