Dupuytren

1. DUPUYTREN CONTRACTURE
PONNILAVAN

2. Proliferative Fibroplasia of Subcutaneous palmar tissue
Occurring in the form of Nodules and cords
Resulting in Secondary progressive & irreversible finger joint flexion contracture

3. Other secondary changes
• Subcutaneous fat thinning
• Adhesion to skin
• Pitting or dimpling of skin

4. DUPUYTREN DIATHESIS
• Prone for progressive & recurrent disease
• ECTOPIC DEPOSITS OF DUPUYTREN DISEASE
- Ledderhose disease- 5% of patients with dupuytren disease have
similar lesion in medial plantar fascia of one or both feet.
- Peyronie disease – 3% patients have plastic penile induration
- Garrod nodules/ Knuckle pads – dorsum of PIP joints

5. • Age - 40- 60 years
• Male – 10 times common than female
• According to Mc Farlane, the disease occurs significantly earlier in
men than women
• Common in individuals of Scandinavian & Celtic origin
• Associated with diabetes, epilepsy, alcoholism, smoking
• 45% bilateral
• Rarely symmetrical

6. • Exact cause – unknown
• Contributing factors –
Hand trauma
Autosomal dominant inheritance
Vascular insufficiency
Smoking

7. PATHOGENESIS
Increased fibroblasts proliferation
Type III collagen deposition
Uncontrolled palmar fascia growth
Flexion
contracture

8. Normal band becomes
diseased cords leading to
PIP contracture

9. LUCK CLASSIFICATION
• Proliferative
• Involutional
• Residual

10. Clinical features
• Lesion begins usually on ulnar side of hand at distal palmar crease
which progress to involve ring finger > little finger > than other digits
combined
• MCP & PIP joint contracture
• Itching or occasional pain early in development of nodules

11. TREATMENT
• Nonoperative –
• Clostridial collagenase injection for MCP & PIP contracture release

12. OPERATIVE
• Indications –
• Positive Hueston test / Table top test – inability to place hand flat on
table

13. Indications
• MCP flexion contracture > 30 degrees
• Any PIP Flexion contracture

14. OPERATIVE
• Percutaneous needle aponeurotomy – in elderly patients with low
demand.
• Open palm McCash technique
Other surgical procedures –
• Subcutaneous fasciotomy by Luck
• Partial/Selective fasciotomy
• Complete fasciotomy
• Fasciectomy with SSG

15. THANK YOU
• Campbell 12 th edition