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Dupuytren Disease

HOSPITAL GARCIA DE ORTA E.P.E.


Serviço de Ortopedia Traumatologia
Director Dr. Craveiro Lopes

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

Hospital Garcia de Orta - Almada


Director - Dr. Craveiro Lopes
Introduction

 1st described – Guillaume Dupuytren (1831)

 Palmar Fibromatosis

 Incidence – male related

 Prevalence – northern Europe

 Risk factors – diabetes, alcohol, tobacco

 PIP contracture – 4th and 5th fingers


PIP Contracture

Persistent deformity after distal selective fascectomy


 Amputation of medial and distal phalanx
 Ressection of medial phalange
 Arthrodesis
– Open

– Fixation with Kirschner wire

 Joint replacement???
PIP Contracture

Amputation of the medial and distal phalange


 Phalanx or finger – mostly 5th finger

 Severe functional deficit or vascular injury

 Recurrent disease
PIP Contracture

Ressection of medial phalange

 Preservation tip finger

 Less inesthetic

 Avoid pseudoboutonnière

 Good functional outcome


PIP Contracture

Arthrodesis

 Open or fixation with K-wire

 Good functional outcome

 DIP extension – Pseudoboutonnière


Material and Methods

 2000-2006
 119 patients operated

 102 patients evaluated – 120 hands – 196 rays

 7 PIP arthrodesis

 16 complications

 4 reoperated
Objectives

 Evaluate the influence of comorbidities –

diabetes

 Evaluate the influence of tobacco and alcohol in

the prevalence and evolution of the disease

 Evaluate the quality of treatment


Results

 Gender  Age of beginning of the disease


M:F = 6:1

Average interval between beginning the disease and surgery – 10,78 years
Results
 Operated rays

 Bilateral cases – 17 patients


Results

 Tubiana Classification

 Pre-operative
Average: 2,49 (0-4)

 Post-operative
Average: 0,84 (0-3)
Results

 Tobacco  Alcohol

 Positive family history – 18%


Results
 Comorbidities  Hand pathology
Results

 Surgery

− Palmar selective fasciectomy

 Carpal tunnel syndrome surgery – 19 hands

 PIP arthrodesis – 7 rays

 Reoperated – 4 patients
Results

 Complications
Sudeck’s athrophy 3

Dysesthesia 9

Infection 3

Hypertrophic scars 1

Skin cicatrization problems 15


Results

 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)

No-diabetes 0,67 (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)

No-alcohol 0,59 (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)

Non-smoking 0,88 (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

 Excellent and good results: 74%

 Diabetes – related to disease recurrence and complications

 Tobacco and Alcohol – not related? (≠ other studies)

 PIP arthrodesis – small nº of patients

 PIP arthrodesis – better results in recurrent disease?


OBRIGADO!

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