Patterns of the Diseased Fascia in the Fingers in Dupuytrenʼs Contracture

McFarlane, Robert M.

doi:10.1097/00006534-197407000-00004

Cited by 171 publications

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“…It may involve cutaneous ligaments to varying degrees (McFarlane, 1974;Barton, 1984). Cleland's ligaments are never diseased in Duputren's contracture but Grayson's ligaments which are thinner and delicate than Cleland's ligaments often diseased in Duputren's contracture.…”

Section: Discussionmentioning

confidence: 99%

Morphological Study of Cutaneous Ligaments of Phalanges

Sabnis

2013

Int. J. Morphol.

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SUMMARY:The cutaneous ligaments of phalanges of palm and foot are fine and sender fibrous strips running from tendon sheath to flexor and extensor aspect of skin over phalanges. They are playing important role in stabilizing skin during movements and supporting digital neurovascular bundle. Such ligaments have carried lot of surgical value in microsurgery of hand. The morphology of such ligaments is studied in 80 digits of 8 cadavers of 20-80 years (6 males and 2 females). They are studied in detail in terms of attachments, thickness & length. The morphological data will be helpful in surgical implication of Duputren's Contracture, replantation, revascularization of the digit.

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Section: Discussionmentioning

confidence: 99%

Morphological Study of Cutaneous Ligaments of Phalanges

Sabnis

2013

Int. J. Morphol.

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“…34,52 By contrast, PNF is a less invasive technique where the cord is sectioned with a 25-gauge needle mounted on a syringe. 21 PNF is recommended by NICE IPG43 and is considered particularly suitable for older people who are unfit for, or may not tolerate, major surgery.…”

Section: Surgical Interventions For Dupuytren's Diseasementioning

confidence: 99%

Collagenase clostridium histolyticum for the treatment of Dupuytren’s contracture: systematic review and economic evaluation

Brazzelli

Cruickshank

Tassie

et al. 2015

Health Technol Assess

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BackgroundDupuytren’s disease is a slowly progressive condition of the hand, characterised by the formation of nodules in the palm that gradually develop into fibrotic cords. Contracture of the cords produces deformities of the fingers. Surgery is recommended for moderate and severe contractures, but complications and/or recurrences are frequent. Collagenase clostridium histolyticum (CCH) has been developed as a minimally invasive alternative to surgery for some patients.ObjectivesTo assess the clinical effectiveness and cost-effectiveness of collagenase as an alternative to surgery for adults with Dupuytren’s contracture with a palpable cord.Data sourcesWe searched all major electronic databases from 1990 to February 2014.Review methodsRandomised controlled trials (RCTs), non-randomised comparative studies and observational studies involving collagenase and/or surgical interventions were considered. Two reviewers independently extracted data and assessed risk of bias of included studies. A de novo Markov model was developed to assess cost-effectiveness of collagenase, percutaneous needle fasciotomy (PNF) and limited fasciectomy (LF). Results were reported as incremental cost per quality-adjusted life-year (QALY) gained. Deterministic and probabilistic sensitivity analyses were undertaken to investigate model and parameter uncertainty.ResultsFive RCTs comparing collagenase with placebo (493 participants), three RCTs comparing surgical techniques (334 participants), two non-randomised studies comparing collagenase and surgery (105 participants), five non-randomised comparative studies assessing various surgical procedures (3571 participants) and 15 collagenase case series (3154 participants) were included. Meta-analyses of RCTs assessing CCH versus placebo were performed. Joints randomised to collagenase were more likely to achieve clinical success. Collagenase-treated participants experienced significant reduction in contracture and an increased range of motion compared with placebo-treated participants. Participants treated with collagenase also experienced significantly more adverse events, most of which were mild or moderate. Four serious adverse events were observed in the collagenase group: two tendon ruptures, one pulley rupture and one complex regional pain syndrome. Two tendon ruptures were also reported in two collagenase case series. Non-randomised studies comparing collagenase with surgery produced variable results and were at high risk of bias. Serious adverse events across surgery studies were low. Recurrence rates ranged from 0% (at 90 days) to 100% (at 8 years) for collagenase and from 0% (at 2.7 years for fasciectomy) to 85% (at 5 years for PNF) for surgery. The results of the de novo economic analysis show that PNF was the cheapest treatment option, whereas LF generated the greatest QALY gains. Collagenase was more costly and generated fewer QALYs compared with LF. LF was £1199 more costly and generated an additional 0.11 QALYs in comparison with PNF. The incremental cost-effectiveness ratio was £10,871 per QALY gained. Two subgroup analyses were conducted for a population of patients with moderate and severe disease and up to two joints affected. In both subgroup analyses, collagenase remained dominated.LimitationsThe main limitation of the review was the lack of head-to-head RCTs comparing collagenase with surgery and the limited evidence base for estimating the effects of specific surgical procedures (fasciectomy and PNF). Substantial differences across studies further limited the comparability of available evidence. The economic model was derived from a naive indirect comparison and was hindered by a lack of suitable data. In addition, there was considerable uncertainty about the appropriateness of many assumptions and parameters used in the model.ConclusionsCollagenase was significantly better than placebo. There was no evidence that collagenase was clinically better or worse than surgical treatments. LF was the most cost-effective choice to treat moderate to severe contractures, whereas collagenase was not. However, the results of the cost–utility analysis are based on a naive indirect comparison of clinical effectiveness, and a RCT is required to confirm or refute these findings.Study registrationThis study is registered as PROSPERO CRD42013006248.FundingThe National Institute for Health Research Health Technology Assessment programme.

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“…As the cord matures, it contracts and becomes more fibrotic, taking on a more distinct tendon-like appearance and resulting in flexion contractures of the digits. 4 In the palm, the most common cord is the precentral cord, which arises from the precentral band of the palmar fascia and typically results in a flexion deformity of the metacarpophalangeal (MCP) joint. Other cords in the palm include the vertical and natatory cords (arising respectively from the vertical bands of Legueu and Juvara and the natatory ligaments), although these are less common than the precentral cord.…”

Section: Clinical Presentation and Anatomymentioning

confidence: 99%

“…5 In the fingers, the most common cords are the central, lateral, and spiral cord. 4 The central cord is an extension of the precentral cord that forms in the midline of the fingers and attaches to the flexor tendon sheath. This cord can cause deformities in the MCP joint and proximal interphalangeal (PIP) joint.…”

Section: Clinical Presentation and Anatomymentioning

confidence: 99%

Molecular mechanisms and treatment strategies for Dupuytren’s disease

O’Gorman¹,

Vi²,

Gan

2010

TCRM

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Dupuytren's disease (DD) is a common disease of the hand and is characterized by thickening of the palmar fascia and formation of tight collagenous disease cords. At present, the disease is incurable and the molecular pathophysiology of DD is unknown. Surgery remains the most commonly used treatment for DD, but this requires extensive postoperative therapy and is associated with high rates of recurrence. Over the past decades, more indepth exploration of the molecular basis of DD has raised the hopes of developing new treatment modalities. This paper reviews the clinical presentation and molecular pathophysiology of this disease, as well as current and emerging treatment. It also explores the implications of new findings in the laboratory for future treatment.

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Patterns of the Diseased Fascia in the Fingers in Dupuytrenʼs Contracture

Cited by 171 publications

References 0 publications

Morphological Study of Cutaneous Ligaments of Phalanges

Morphological Study of Cutaneous Ligaments of Phalanges

Collagenase clostridium histolyticum for the treatment of Dupuytren’s contracture: systematic review and economic evaluation

Molecular mechanisms and treatment strategies for Dupuytren’s disease

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Patterns of the Diseased Fascia in the Fingers in Dupuytrenʼs Contracture

Cited by 171 publications

References 0 publications

Morphological Study of Cutaneous Ligaments of Phalanges

Morphological Study of Cutaneous Ligaments of Phalanges

Collagenase clostridium histolyticum for the treatment of Dupuytren’s contracture: systematic review and economic evaluation

Molecular mechanisms and treatment strategies for Dupuytren&rsquo;s disease

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Molecular mechanisms and treatment strategies for Dupuytren’s disease