Arthrodesis of the Proximal Interphalangeal Joint in Dupuytren Contracture: A Qualitative Systematic Review

Abstract

Introduction One of the typical features of Dupuytren contracture is its tendency for recurrence. Reintervention surgery has a high rate of complications, which increases with successive surgeries. Repeated fasciectomies can be contraindicated in severe, recurrent contractures, with arterial insufficiency or poor-quality soft tissue, due to a risk of severely compromising the viability of the skin. In these cases, finger amputation can be avoided by performing arthrodesis of the proximal interphalangeal (PIP) joint. Arthrodesis is also an alternative to amputation in contracted fingers affected by arthritis or arthrofibrosis of the PIP joint. Knowledge about this procedure is scarce due to its rarity. We performed a qualitative systematic review of the results and complications of arthrodesis of the PIP joint of digits 2 to 5 in adults with Dupuytren contracture.

Materials and Methods Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, we conducted a search on the PubMed, Cochrane and Embase databases. The risk of bias was assessed with the modified Newcastle-Ottawa Scale. We recorded the intraoperative and postoperative variables, and those related to complications, improvement in pain and function, and the level of patient satisfaction.

Results For the systematic review, we selected 4 case series totalling 65 patients and 71 arthrodesis. Significant improvements in terms of pain and function were not observed, but, in all studies, patient satisfaction was high. The rate of complication was of 11.3%, and they included 1 case of skin necrosis, but no vascular or nervous lesions were observed.

Conclusion Despite the fact that no improvements in pain or function were reported, this procedure is associated with a high level of patient satisfaction, and an extremely low rate of skin ailments or vascular or nervous lesions. The level of evidence regarding the results and complications is low

Keywords

Dupuytren contracture - arthrodesis - systematic review

Ethical responsibilities

The authors declare that the procedures complied with the standards of the institutional Clinical Research Ethics Committee (which approved this study) and the Declaration of Helsinki.

Data confidentiality

The authors declare that they have followed the protocols of their work center on the publication of patient data.

Publication History

Received: 09 October 2021

Accepted: 07 October 2022

Article published online:
16 December 2022

• Referencias

• 1 Dutta A, Jayasinghe G, Deore S. et al. Dupuytren's Contracture - Current Concepts. J Clin Orthop Trauma 2020; 11 (04) 590-596 DOI: 10.1016/j.jcot.2020.03.026.
• 2 Mármol-Soler S, Espejo-Ortega L, Gutiérrez-Ortega C. et al. Tratamiento no quirúrgico de la contractura de Dupuytren con colagenasa de Clostridium hystoliticum. Cirugia Plastica Ibero-Latinoamericana 2013; 39 (03) 247-254
• 3 Couto González I, Máiz Bescansa J, Taboada Suárez A, Brea García B, González Álvarez E. Enfermedad de Dupuytren en una población del noroeste de España: hallazgos clínicos en 184 pacientes. Cirugia Plastica Ibero-Latinoamericana 2010; 36 (02) 145-154
• 4 Soreide E, Murad MH, Denbeigh JM. et al. Treatment of Dupuytren's contracture: a systematic review. Bone Joint J 2018; 100-B [phone] DOI: 10.1302/0301-620X.100B9.BJJ-2017-1194.R2.
• 5 Rodrigues JN, Becker GW, Ball C. et al. Surgery for Dupuytren's contracture of the fingers. Cochrane Database Syst Rev 2015; 2015 (12) CD010143
• 6 Felici N, Marcoccio I, Giunta R. et al. Dupuytren contracture recurrence project: reaching consensus on a definition of recurrence. Handchir Mikrochir Plast Chir 2014; 46 (06) 350-354 DOI: 10.1055/s-0034-1394420.
• 7 Chen NC, Srinivasan RC, Shauver MJ, Chung KC. A systematic review of outcomes of fasciotomy, aponeurotomy, and collagenase treatments for Dupuytren's contracture. Hand (N Y) 2011; 6 (03) 250-255 DOI: 10.1007/s11552-011-9326-8.
• 8 Lipman MD, Carstensen SE, Deal DN. Trends in the Treatment of Dupuytren Disease in the United States Between 2007 and 2014. Hand (N Y) 2017; 12 (01) 13-20 DOI: 10.1177/1558944716647101.
• 9 Kaplan FTD, Crosby NE. Treatment of Recurrent Dupuytren Disease. Hand Clin 2018; 34 (03) 403-415 DOI: 10.1016/j.hcl.2018.03.009.
• 10 Wong CR, Huynh MNQ, Fageeh R, McRae MC. Outcomes of Management of Recurrent Dupuytren Contracture: A Systematic Review and Meta-analysis. [published online ahead of print, 2021 Feb 22] Hand (N Y) 2021; 1558944721994220: 1558944721994220 DOI: 10.1177/1558944721994220.
• 11 Denkler K. Surgical complications associated with fasciectomy for dupuytren's disease: a 20-year review of the English literature. Eplasty 2010; 10: e15
• 12 Eberlin KR, Mudgal CS. Complications of Treatment for Dupuytren Disease. Hand Clin 2018; 34 (03) 387-394 DOI: 10.1016/j.hcl.2018.03.007.
• 13 Traboulsi-Garet B, Camps-Font O, Traboulsi-Garet M, Gay-Escoda C. Buccal fat pad excision for cheek refinement: A systematic review. Med Oral Patol Oral Cir Bucal 2021; 26 (04) e474-e481
• 14 Watson HK, Lovallo JL. Salvage of severe recurrent Dupuytren's contracture of the ring and small fingers. J Hand Surg Am 1987; 12 (02) 287-289 DOI: 10.1016/s0363-5023(87)80291-5.
• 15 Novoa-Parra CD, Montaner-Alonso D, Pérez-Correa JI, Morales-Rodríguez J, Rodrigo-Pérez JL, Morales-Suarez-Varela M. Arthrodesis of the proximal interphalangeal joint of the 4th and 5th finger using an interlocking screw device to treat severe recurrence of Dupuytren's disease. Rev Esp Cir Ortop Traumatol (Engl Ed) 2018; 62 (03) 216-221 DOI: 10.1016/j.recot.2017.10.012. (Engl Ed)
• 16 Pillukat T, Walle L, Stüber R, Windolf J, van Schoonhoven J. Rezidiveingriffe beim Morbus Dupuytren. Orthopade 2017; 46 (04) 342-352 DOI: 10.1007/s00132-017-3385-7.
• 17 Bolt AM, Giele H, McNab ISH, Spiteri M. Outcome of arthrodesis for severe recurrent proximal interphalangeal joint contractures in Dupuytren's disease. J Hand Surg Eur Vol 2021; 46 (04) 403-405 DOI: 10.1177/1753193420960309.
• 18 Jensen CM, Haugegaard M, Rasmussen SW. Amputations in the treatment of Dupuytren's disease. J Hand Surg [Br] 1993; 18 (06) 781-782 DOI: 10.1016/0266-7681(93)90245-B.
• 19 Jung J, Haghverdian B, Gupta R. Proximal Interphalangeal Joint Fusion: Indications and Techniques. Hand Clin 2018; 34 (02) 177-184 DOI: 10.1016/j.hcl.2017.12.007.
• 20 Fram BR, Seigerman DA, Cross DE. et al. The Optimal Position for Arthrodesis of the Proximal Interphalangeal Joints of the Border Digits. J Hand Surg Am 2020; 45 (07) 656.e1-656.e8 DOI: 10.1016/j.jhsa.2019.11.008.
• 21 Vandecasteele L, Degreef I. Pain in Dupuytren's disease. Acta Orthop Belg 2020; 86 (03) 555-562
• 22 Vlot MA, Wilkens SC, Chen NC, Eberlin KR. Symptomatic Neuroma Following Initial Amputation for Traumatic Digital Amputation. J Hand Surg Am 2018; 43 (01) 86.e1-86.e8 DOI: 10.1016/j.jhsa.2017.08.021h.
• 23 Ball C, Pratt AL, Nanchahal J. Optimal functional outcome measures for assessing treatment for Dupuytren's disease: a systematic review and recommendations for future practice. BMC Musculoskelet Disord 2013; 14: 131
• 24 Poelstra R, van Kooij YE, van der Oest MJW, Slijper HP, Hovius SER, Selles RW. Hand-Wrist Study Group. Patient's satisfaction beyond hand function in Dupuytren's disease: analysis of 1106 patients. J Hand Surg Eur Vol 2020; 45 (03) 280-285 DOI: 10.1177/1753193419890284.
• 25 Krefter C, Marks M, Hensler S, Herren DB, Calcagni M. Complications after treating Dupuytren's disease. A systematic literature review. Hand Surg Rehabil 2017; 36 (05) 322-329 DOI: 10.1016/j.hansur.2017.07.002.
• 26 Honecker S, Hidalgo Diaz JJ, Naito K. et al. Proximodistal interphalangeal arthrodesis of the little finger: A series of 7 cases. Hand Surg Rehabil 2016; 35 (04) 262-265 DOI: 10.1016/j.hansur.2016.06.003.