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Percutaneous Needle Fasciotomy for Dupuytren Contracture

Strömberg, Joakim, MD, PhD1,2

JBJS Essential Surgical Techniques: March 26, 2019 - Volume 9 - Issue 1 - p e6
doi: 10.2106/JBJS.ST.18.00047
Subspecialty Procedures
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Disclosures

Background: Percutaneous needle fasciotomy (PNF) is a minimally invasive treatment option for mild to moderate Dupuytren contractures in the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints, and the procedure requires limited resources. Multiple contractures can be treated during the same session, and the treatment is considerably easier for the patient and requires a minimum of rehabilitation compared with limited fasciectomy1.

Description: PNF can be performed in a regular outpatient clinic in most cases. With the patient in a reclined position, the cord of the contracted joint is tensioned by passive extension and is divided percutaneously with a 25-gauge needle under local anesthesia. The immediate treatment effect in terms of reduction of the contracture is readily assessed, and PNF can be performed at additional levels if needed.

Alternatives: 

  • Collagenase Clostridium histolyticum (CCH; Xiaflex).
  • Total or partial fasciectomy.
  • Dermofasciectomy.
  • Amputation (in severe cases after multiple other procedures).

Rationale: Local treatment with injection of CCH (Xiaflex) in the Dupuytren cord enables rupture of the cord similar to that after PNF2. Both CCH and PNF are minimally invasive treatments with obvious advantages compared with open surgery3, and they seem to have the same intermediate-term outcome4-6. However, CCH treatment is considerably more expensive than PNF and requires 2 visits by the patient to the outpatient clinic instead of 17. CCH has also been reported to have more complications than PNF2,8. Furthermore, multiple (>4) joint contractures9 can be treated by PNF at the same time. In the author’s experience, even bilateral contractures can be treated at the same session if requested by the patient. As the number of patients treated with CCH and PNF has increased, there has been a corresponding decrease in more invasive procedures10; however, open surgery will probably always remain an option in more severe cases or as a secondary procedure after recurrence.

1Department of Hand Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden

2Centre for Advanced Reconstruction of Extremities, Sahlgrenska University Hospital, Mölndal, Sweden

E-mail address: joakim.stromberg@vgregion.se

Disclosure: The author indicated that no external funding was received for any aspect of this work. The Disclosure of Potential Conflicts of Interest form is provided with the online version of the article (http://links.lww.com/JBJSEST/A238).

Copyright © 2019 by The Journal of Bone and Joint Surgery, Incorporated
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