Dupuytren’s Disease – Research Update

25 Oct 2018

Dupuytren’s Disease has been described as “the most common crippling hand condition that most people have never heard of”, however, it is a common condition in the Australian and Tasmanian populations.

The palm of the hand contains a deep layer of tissue called palmar fascia, which extends across the palm to the fingers. In patients with Dupuytren’s Disease, this palmar fascia slowly begins to thicken, then tighten, and gradually causes clawing of the fingers as they are pulled towards the palm, resulting in what is known as a Dupuytren’s contracture.

In many cases, a Dupuytren’s contracture progresses very slowly, over a period of years. In moderate or severe cases, the condition makes it difficult to straighten the involved fingers. Typically, as a contracture worsens a significant impairment of function occurs which requires surgical intervention.

The gold standard of treatment is a surgical procedure which removes the affected tissue. More recently less invasive procedures have gained recognition as alternative treatment. Despite an increased recurrence rate with these procedures, they provide a viable option which may either delay or prevent the need for surgical intervention.

LGH plastic surgeon, Dr Michael Thompson, is undertaking a Clifford Craig funded research study to compare two
of these less invasive treatment options – (1) injectable Collagenase (CollA) and (2) Percutaneous Needle Fasciotomy (PNF) – with regard to patient outcomes and cost-effectiveness.

Percutaneous Needle Fasciotomy is a short procedure which is undertaken in an office setting under local anaesthetic, whereby the Dupuytren cord is divided

through repeated perforations with a needle. The injectable Collagenase method is a similarly short procedure whereby the CollA is injected at one consultation and the cord released at a second a day later.

Dr Thompson’s study will involve a comparison of the two treatment options upon the metacarpophalangeal joint and proximal interphalangeal joint, plus under the surface of the foot where contractures can also form. The study will also determine the costs of various treatment options (including surgical) and perform economic modelling to examine the cost-effectiveness of different treatment. The outcomes of this study will help guide treatment protocols of this common Australian condition.

The necessary study establishment requirements are nearing completion and patient recruitment for the project will commence shortly.

Fast Facts

• Dupuytren’s Disease is a thickening and shortening of tissue in the palm, resulting in clawed fingers as they are pulled toward the hand.

• The cause is unknown, but risk factors include advancing age, Scandinavian and Celtic ancestry, and certain conditions such as epilepsy and diabetes.

• Treatment depends on the severity of the condition and may involve surgical or non-surgical