Predictors of Outcomes Following Fasciectomy for Dupuytren’s Disease in Diabetic and Non-Diabetic Patients

Abstract

Background: The aim of this study was to compare clinical outcomes, and identify predictors thereof, after fasciectomy for Dupuytren’s disease in a series of diabetic patients compared with non-diabetic patients. Methods: Thirty-eight patients were examined following partial palmar and/or digital fasciectomy for Dupuytren’s disease (11 diabetics, 27 non-diabetics). Each patient was assessed for degree of pre- and post-operative flexion contractures at the MCP and PIP joints, post-operative Patient Evaluation Measure (PEM) total score, post-operative grip strength, limited joint mobility (LJM), recurrence, extension, and a composite outcomes score based upon grip strength and the degree of joint contractures. All measurements in the diabetic cohort were compared to those in the non-diabetic group, and a logistic regression analysis was performed to identify the predictive value of several variables on outcomes. Results: Complication rates between the two groups were statistically similar (p = 0.67). There were no significant differences in pre-operative MCP (p = 0.69), post-operative MCP (p = 0.39), pre-operative PIP (p = 0.40), or post-operative PIP (p = 0.13) joint flexion contractures between the two groups. Additionally, there was no significant difference in extension (p = 0.35) or recurrence (p~1) rates, post-operative grip strengths (p = 0.64), or PEM total scores (p = 0.32). However, the rate of LJM was significantly higher in the diabetic population (p = 0.02). Both female gender (p = 0.01) and a non-smoking status (p = 0.04) were found to be predictive of better outcomes following fasciectomy. Diabetes was not found to be an independent predictor of outcome (p = 0.73). Conclusions: Clinical results after fasciectomy for Dupuytren’s disease in diabetic patients are not different from results obtained in non-diabetic patients. Diabetes is not independently predictive of surgical outcomes. Female gender and non-smoking status are independent predictors of a better outcome following fasciectomy.

Circulating inflammatory cytokines alter transcriptional activity within fibrotic tissue of Dupuytren's disease patients

“…In fact, the prevalence of DD in patients with diabetes is as high as 42% 40,41 . Perhaps surprisingly, DD is not associated with the severity of the diabetes, and diabetes does not independently predict surgical outcomes following partial palmar and/or digital fasciectomy 38,42 . Consistent with this notion, we did not find any significant differences in inflammatory cytokines between diabetic and nondiabetic DD subjects in this study.…”

Hand–arm vibration and outcomes of surgery for Dupuytren’s contracture

“…Binary logistic regression was used to investigate predictors of satisfaction. Age and sex were selected as covariates as these influence PROMs in other hand conditions [4]. The level of statistical significance was set at p<0.05.…”