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Patterns of Dupuytren Disease in Fingers: Studying Correlations with a Multivariate Ordinal Logit Model

Lanting, Rosanne M.D.; Nooraee, Nazanin M.Sc.; Werker, Paul M. N. M.D., Ph.D.; van den Heuvel, Edwin R. Ph.D.

Plastic & Reconstructive Surgery: September 2014 - Volume 134 - Issue 3 - p 483–490
doi: 10.1097/PRS.0000000000000429
Hand/Peripheral Nerve: Original Article

Background: Dupuytren disease affects fingers in a variable fashion. Knowledge about specific disease patterns (phenotype) based on location and severity of the disease is lacking.

Methods: In this cross-sectional study, 344 primary affected hands with Dupuytren disease were physically examined. The Pearson correlation coefficient between the coexistence of Dupuytren disease in pairs of fingers was calculated, and agglomerative hierarchical clustering was applied to identify possible clusters of affected fingers. With a multivariate ordinal logit model, the authors studied the correlation on severity, taking into account age and sex, and tested hypotheses on independence between groups of fingers.

Results: The ring finger was most frequently affected by Dupuytren disease, and contractures were seen in 15.1 percent of affected rays. The severity of thumb and index finger, middle and ring fingers, and middle and little fingers was significantly correlated. Occurrences in pairs of fingers were highest in the middle and ring fingers and lowest in the thumb and index finger. Correlation between the ring and little fingers and a correlation between fingers from the ulnar and radial sides could not be demonstrated.

Conclusions: Rays on the ulnar side of the hand are predominantly affected. The middle finger is substantially correlated with other fingers on the ulnar side, and the thumb and index finger are correlated; however, there was no evidence that the ulnar side and the radial side were correlated in any way, which suggests that occurrence on one side of the hand does not predict Dupuytren disease on the other side of the hand.

CLINCIAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

Groningen, The Netherlands

From the Departments of Plastic Surgery and Epidemiology, University of Groningen, University Medical Center Groningen.

Received for publication December 9, 2013; accepted March 6, 2014.

Disclosure: Dr. Werker has been a consultant for the pharmaceutical company Pfizer while it was handling Xiapex in Europe. Dr. van den Heuvel is a consultant for Merck. The other authors have no financial or other conflict of interest.

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Rosanne Lanting, M.D., Department of Plastic Surgery, HPC BB81, Hanzeplein 1, P.O. Box 30.001, 9700 RB Groningen, The Netherlands, r.lanting@umcg.nl

©2014American Society of Plastic Surgeons