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J Orthop Surg (Hong Kong). 2008 Apr;16(1):88-90.

Needle aponeurotomy for Dupuytren's contracture

Cheng HS, Hung LK, Tse WL, Ho PC.

PURPOSE. To review the efficacy and safety of needle aponeurotomy for Dupuytren's contracture in Chinese patients. METHODS. Seven men and one woman aged 50 to 80 (mean, 67) years underwent needle aponeurotomy for Dupuytren's contracture. Five were manual workers and the other 3 were retired. Their chief complaints were difficulty moving the fingers, clumsiness of the hand, and occasional pain in the palm. No patient had any family history of Dupuytren's contracture. RESULTS. 41 points were released in 13 fingers (3 middle, 3 ring, and 7 little). Immediately after release, the respective mean flexion contracture correction of the metacarpophalangeal and proximal interphalangeal joints were 50 (from 50 to 0) and 35 (from 46 to 11) degrees. At 22-month follow-up, the respective mean residual flexion contracture of both joints were 12 and 27 degrees; the corresponding long-term improvements were 70 and 41%. No patient had a wound complication or neurovascular injury. All had a normal score for Disabilities of the Arm, Shoulder, and Hand. CONCLUSION. For Chinese patients with Dupuytren's contracture, needle aponeurotomy is safe and effective. Long-term correction is better maintained in metacarpophalangeal than proximal interphalangeal joints (70 vs 41%).

PMID: 18453667 [PubMed - in process]

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J Hand Surg [Br]. 2003 Oct;28(5):427-31.

Percutaneous needle aponeurotomy: complications and results

Foucher G, Medina J, Navarro R.

SOS main Strasbourg, clinique du Parc, 4, boulevard du Président Edwards, 67000 Strasbourg, France. ifssh@aol.com

Recently French rheumatologists have repopularized fasciotomy using a percutaneous needle technique. This blind approach has been claimed to be plagued by numerous complications. We reviewed the charts of 211 patients treated consecutively on 261 hands and 311 fingers to assess the rate of postoperative complications. The first 100 patients were evaluated with a mean follow up of 3.2 years to assess the rate of recurrences and extension of the disease. In the whole group the mean age was 65 years and delay between onset and treatment was 6 years. Division of the cords were performed only in the palm in 165 cases, in the palm and finger in 111 and purely in the finger in 35. Complications were scarce without infection or tendon injury but one digital nerve was found injured during a second procedure. Postoperative gain was prominent at metacarpophalangeal joint level (79% versus 65% at interphalangeal level). The reoperation rate was 24%. In the group assessed at 3.2 years follow up, the recurrence rate was 58% and disease "activity" 69%. Fifty nine hands need further surgery. The ideal indication for this simple and reliable technique is an elderly patient with a bowing cord and predominant MP contracture.

PMID: 12954251 [PubMed - indexed for MEDLINE]

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Ann Chir Plast Esthet. 1998 Dec;43(6):593-9.

What's new in the treatment of Dupuytren's disease?

Foucher G, Lallemand S, Pajardi G.

SOS Main Strasbourg, Clinique du Parc, France.

Among the recent advances in the field of Dupuytren's contracture, the authors reviewed a series of 171 patients treated by percutaneous needle fasciotomy. Among the 198 hands (241 fingers), 65 were reviewed with a mean follow-up of 2.5 years. Mean age was 62 years and delay between onset and treatment 6.8 years. Rupture of the cords was performed only in the palm in 154 cases, palmo-digital in 82 and purely digital in 5 cases. Complications were rare and benign without tendon or vascular bundle injury. Postoperative gain was essentially observed on the metacarpo-phalangeal joint and recurrence rate was high despite the short follow-up (progression of the disease 54% of cases). The ideal indication for this simple and reliable technique is an elderly patient with a prominent cord and predominant lack of metacarpophalangeal extension.