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Unidade de Cirurgia
da mão e membro superior
Hospital Garcia de Orta – Almada
Júlio André
Fernando Cruz
Mª José Maio
Dupuytren Disease
Pedro Simas
Leonor Fernandes
Teresa Marques
Júlio André Almeida
Palmar Fibromatosis
Joint replacement???
PIP Contracture
Recurrent disease
PIP Contracture
Less inesthetic
Avoid pseudoboutonnière
Arthrodesis
2000-2006
119 patients operated
7 PIP arthrodesis
16 complications
4 reoperated
Objectives
diabetes
Average interval between beginning the disease and surgery – 10,78 years
Results
Operated rays
Tubiana Classification
Pre-operative
Average: 2,49 (0-4)
Post-operative
Average: 0,84 (0-3)
Results
Tobacco Alcohol
Surgery
Reoperated – 4 patients
Results
Complications
Sudeck’s athrophy 3
Dysesthesia 9
Infection 3
Hypertrophic scars 1
Patients satisfaction
or
nt
r
o
i
lle
Po
o
Fa
G
ce
Ex
Analysis of Results
Diabetes
Tubiana Classification Post-operative
Diabetes 1,14 (0-3)
Complications
- Diabetes: 46% and No-diabetes: 18% p<0,01
Recurrences
p<0,01
- Diabetes: 30% and No-diabetes: 17%
Analysis of Results
Alcohol
Tubiana Classification Post-operative
Alcohol 0,91 (0-3)
Complications
- Alcohol: 24% and No-alcohol: 33% p>0,01
Recurrences
p>0,01
- Alcohol: 19% and No-alcohol: 21%
Analysis of Results
Tobacco
Tubiana Classification Post-operative
Smoking 0,83 (0-3)
Complications
- Smoking: 28% and Non-smoking: 26% p>0,01
Recurrences
p>0,01
- Smoking: 18% and Non-smoking: 22%
Analysis of Results
PIP
PIP arthrodesis
− Persistent deformity uncorrected by distal fascectomy
− Arthrodesis – fixation with Kirschner wires
6 patients/ 7 rays
Gender Diabetes Tobacco Ray Recurrency Satisfaction
M Yes Yes R5 Yes Good
F Yes No R5 Yes Good
M No No R4,R5 No Fair
M No Yes R5 No Fair
M No Yes R5 No Bad
M No No R5 No Deceased
Conclusions