Proximal Interphalangeal Joint Release in Dupuytren’s Disease of the Little Finger

Abstract

We present a prospective study, with 3-year follow-up, of the role and outcome of fasciectomy plus sequential surgical release of structures of the proximal interphalangeal joint in Dupuytren's contracture of the little finger. Our treatment programme involves fasciectomy for all patients followed by sequential release of the accessory collateral ligament and volar plate as necessary. Of the 19 fingers in the study, eight achieved a full correction by fasciectomy alone, and in these cases there was a fixed flexion deformity of 6 degrees at 3 months and 8 degrees at 3 years. The remaining 11 fingers (initial mean deformity 70 degrees flexion) were left with a fixed flexion deformity of 42 degrees after fasciectomy which reduced to 7 degrees with capsulo-ligamentous release. This increased to 26 degrees at 3 months but then remained relatively stable, increasing only to 29 degrees at 3 years. In our experience sequential proximal interphalangeal joint release has led to consistently good results with few complications in the correction of severe Dupuytren's disease of the little finger.

The association between intraoperative correction of Dupuytren’s disease and residual postoperative contracture

“…We did a sequential release of structures (Andrew, 1991) of the PIPJ if the contracture remained greater than 30 after fasciectomy. Sequential PIPJ release has been shown to give good results with few complications (Ritchie et al, 2004). Abe et al (2004) demonstrated that those with a worse preoperative deformity were more likely to have a worse postoperative outcome.…”

The Prognosis of Fasciectomy for Abductor Digiti Minimi and Pretendinous Cords in Dupuytren's Disease of the Little Finger

“…Larger, multi-centre series would be beneficial to ensure that the lack of significance demonstrated was not due to type II error. In addition, longer follow-up may show increased recurrence however previous studies have shown that loss of correction occurs predominately in the first three months, 6 which is within the timescale of our analysis.…”

“…5 Complete correction is often difficult and recurrence rates are high. [5][6][7][8][9][10] Capsuloligamentous release has been proposed to improved outcomes in some series 5,6,8 but others, even by the same group, have been unable to demonstrate a significant advantage. 9 Van Giffen compared the results of limited fasciectomy, segmental fasciectomy and dermofasciectomy and was unable to demonstrate superiority of any technique as all had equally high rates of recurrent and residual deformity.…”

“…6 We therefore determined the final outcome as the residual contracture present at six months post-operation and prognosis as the likelihood of persistent deformity. At the final assessment the same observer (D. Pearson) measured the contracture present at each joint using a finger goniometer.…”

Dupuytren’s disease: overview of a common connective tissue disease with a focus on emerging treatment options

“…The PIP can be released but that may lead to pain, recurrence, slower rehabilitation and, on occasions, hyperextension laxity. Although there is no consensus, many surgeons will accept the correction achieved by removal of the Dupuytren's cord without need for further surgical attention to the PIP joint, whereas others will release the joint [100].…”