Treatment of Dupuytren's contracture [Behandeling van contracturen van Dupuytren]

Abstract: Bekkering GM, Wubbels SPA, Meijer GMP, Schermer TRJ. Treatment of Dupuytren’s contracture. Huisarts Wet 2015;58(8):406-12. Aim: Percutaneous needle fasciotomy (PNF) is a treatment for Dupuytren’s contracture of the fingers, and in the Netherlands this intervention is usually performed by a plastic surgeon. This study investigated the short-term (6 weeks) results of PNF carried out by a general practitioner. Method: This non-controlled clinical study involved patients with Dupuytren’s contracture treated with PNF by their GP in the practice office. The GP had received appropriate training. The primary outcome was improvement in the total passive extension deficit (TPED) of the contractures. Secondary outcomes were improvement in hand function (score on the DASH-DLV questionnaire) and complications of PNF. Results were compared with those of a previous study using the same outcomes and involving two plastic surgeons. Results: The GP treated 102 fingers of 68 patients with PNF. The mean TPED improvement after 6 weeks was 63[%]; it was 62[%] in the reference study involving plastic surgeons. Most improvement was seen in the metacarpophalangeal joints, namely, 85[%] improvement for PNF performed by the GP and 75[%] improvement for PNF performed by the plastic surgeons. The mean DASH-DLV scores for hand function before and 6 weeks after PNF performed by the GP were 10.8 (95[%] CI 7.6–13.9) and 4.4 (95[%] CI 2.5–6.4), respectively. PNF did not cause severe complications. Conclusion: Despite study differences, it would seem that the short-term results of PNF are similar regardless of whether treatment is provided by a GP or plastic surgeon. Patients should be followed up for longer to see whether treatment results remain similar in the long term. For the moment, there is no reason to stop GPs from performing PNF. © 2015, Bohn Stafleu van Loghum.