Surgical intervention improves symptoms of Dupuytren’s contracture

1. In this randomized controlled trial, the success rate of surgery was greater than that of needle fasciotomy and collagenase injection for treating Dupuytren’s contracture at two years of follow-up.

2. Initial success rates after three months were similar for surgery, needle fasciotomy, and collagenase injection.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Dupuytren’s contracture is a hereditary fibroproliferative disorder characterized by an inability to extend one or more fingers (usually the ring and little fingers) due to progressive shortening of the palmar fascia. It is most prevalent in persons with Northern European backgrounds and is thought to be linked with alcohol use and smoking. While it cannot be cured, symptoms improve when the contracture is released, which can be achieved via surgery, needle fasciotomy, and collagenase injection. Surgery has demonstrated the most durable outcomes but is associated with higher post-procedural morbidity and longer recovery periods compared to the other two percutaneous methods. Previous studies comparing the different treatment modalities are limited to outcomes following a single intervention, although many persons with Dupuytren’s undergo recurrent treatment. No reported studies have compared all three treatments in a parallel fashion. Hence, this ongoing study aimed to investigate the effectiveness of surgery, needle fasciotomy, and collagenase injection in parallel setup with recurrent follow-up to 10 years. At three months, initial success rates were similar for all three interventions. At two years, the success rate of surgery was greater than that of both needle fasciotomy and collagenase injection for the treatment of Dupuytren’s contracture. The trial was susceptible to performance bias due to its lack of participant blinding and limited by its inability to compare the incidence of serious adverse events between the different treatments due to the small sample size.

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In-Depth [randomized controlled trial]: DupuytrEn Treatment EffeCtiveness Trial (DETECT) is an ongoing randomized, outcome assessor-blinded, 3-group (1:1:1) parallel superiority trial comparing the effectiveness of surgery, needle fasciotomy, and collagenase injection in the treatment of persons with treatment-naïve Dupuytren’s contracture with follow-up up to 10 years. Persons referred for the treatment of Dupuytren’s contracture were screened for eligibility by a hand surgeon. They were excluded if they had any other condition affecting the function of the affected finger(s) or if they had severe contracture (> 135 degrees). Enrolled participants were randomized to undergo surgery, needle fasciotomy, or collagenase injection in a 1:1:1 ratio but were not blinded to treatment allocation. Follow-up was planned at three months, two years, five years, and 10 years. The primary outcome was the success rate, defined as greater than 50% contracture release from baseline and the participant reaching an acceptable state of patient symptoms (PASS). Out of a total of 767 participants, 302 were enrolled in the trial. Most of these participants (69%) were treated for a single-finger contracture. Out of 292 participants who completed follow-up at three months, the success rate was 71% (95% Confidence Interval [CI], 62% to 80%) for surgery, 73% (95% CI, 64% to 82%) for needle fasciotomy, and 73% (95% CI, 64% to 82%) for collagenase injection. Out of 284 participants who completed follow-up at two years, surgery had higher success rates compared to needle fasciotomy (78% vs. 50%; adjusted risk difference [aRD], 0.30; 95% CI, 0.17 to 0.43) and collagenase injection (78% vs. 65%; aRD, 0.13; 95% CI, 0.01 to 0.26). In summary, despite similar outcomes at three months, success rates for the treatment of treatment-naïve Dupuytren’s contracture were higher with surgery compared to needle fasciotomy and collagenase injection at two years.

Image: PD

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