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Collagenase injections for Dupuytren's disease: prospective cohort study assessing 2-year treatment effect durability

OBJECTIVES: To assess 2-year durability of joint contracture correction following collagenase injections for Dupuytren's disease. DESIGN: Prospective cohort study. SETTING: Orthopaedic Department in Sweden. PARTICIPANTS: Patients with palpable Dupuytren's cord and active extension deficit...

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Autores principales: Lauritzson, Anna, Atroshi, Isam
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5353323/
https://www.ncbi.nlm.nih.gov/pubmed/28298365
http://dx.doi.org/10.1136/bmjopen-2016-012943
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author Lauritzson, Anna
Atroshi, Isam
author_facet Lauritzson, Anna
Atroshi, Isam
author_sort Lauritzson, Anna
collection PubMed
description OBJECTIVES: To assess 2-year durability of joint contracture correction following collagenase injections for Dupuytren's disease. DESIGN: Prospective cohort study. SETTING: Orthopaedic Department in Sweden. PARTICIPANTS: Patients with palpable Dupuytren's cord and active extension deficit (AED) ≥30° in the metacarpophalangeal (MCP) and/or proximal interphalangeal (PIP) joint. A surgeon injected 0.80 mg collagenase into multiple cord parts and performed finger manipulation under local anaesthesia after 24–48 hours. A hand therapist measured joint contracture before and 5 weeks after injection in all treated patients. Of 57 consecutive patients (59 hands), 48 patients (50 hands) were examined by a hand therapist 24–35 months (mean 26) after injection. Five of the patients had received a second injection in the same finger within 6 months of the first injection. OUTCOME MEASURES: Primary outcome was proportion of treated joints with ≥20° worsening in AED from 5 weeks to 2 years. RESULTS: Between the 5-week and the 2-year measurements, AED had worsened by ≥20° in seven MCP and seven PIP joints (28% of the treated hands; all had received a single injection). Mean AED for the MCP joints was 54° before injection, 6° at 5 weeks and 9° at 2 years and for the PIP joints 30°, 13° and 16°, respectively. For joints with ≥10° contracture at baseline, mean (95 % CI) baseline to 2 years AED improvement was for MCP 49° (41–54) and for PIP 25° (17–32). No treatment-related adverse events were observed at the 2-year follow-up evaluation. CONCLUSIONS: Two years after collagenase injections for Dupuytren's disease, improvement was maintained in 72% of the treated hands. Complete contracture correction was seen in more than 80% of the MCP but in less than half of the PIP joints.
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spelling pubmed-53533232017-03-17 Collagenase injections for Dupuytren's disease: prospective cohort study assessing 2-year treatment effect durability Lauritzson, Anna Atroshi, Isam BMJ Open Surgery OBJECTIVES: To assess 2-year durability of joint contracture correction following collagenase injections for Dupuytren's disease. DESIGN: Prospective cohort study. SETTING: Orthopaedic Department in Sweden. PARTICIPANTS: Patients with palpable Dupuytren's cord and active extension deficit (AED) ≥30° in the metacarpophalangeal (MCP) and/or proximal interphalangeal (PIP) joint. A surgeon injected 0.80 mg collagenase into multiple cord parts and performed finger manipulation under local anaesthesia after 24–48 hours. A hand therapist measured joint contracture before and 5 weeks after injection in all treated patients. Of 57 consecutive patients (59 hands), 48 patients (50 hands) were examined by a hand therapist 24–35 months (mean 26) after injection. Five of the patients had received a second injection in the same finger within 6 months of the first injection. OUTCOME MEASURES: Primary outcome was proportion of treated joints with ≥20° worsening in AED from 5 weeks to 2 years. RESULTS: Between the 5-week and the 2-year measurements, AED had worsened by ≥20° in seven MCP and seven PIP joints (28% of the treated hands; all had received a single injection). Mean AED for the MCP joints was 54° before injection, 6° at 5 weeks and 9° at 2 years and for the PIP joints 30°, 13° and 16°, respectively. For joints with ≥10° contracture at baseline, mean (95 % CI) baseline to 2 years AED improvement was for MCP 49° (41–54) and for PIP 25° (17–32). No treatment-related adverse events were observed at the 2-year follow-up evaluation. CONCLUSIONS: Two years after collagenase injections for Dupuytren's disease, improvement was maintained in 72% of the treated hands. Complete contracture correction was seen in more than 80% of the MCP but in less than half of the PIP joints. BMJ Publishing Group 2017-03-15 /pmc/articles/PMC5353323/ /pubmed/28298365 http://dx.doi.org/10.1136/bmjopen-2016-012943 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
spellingShingle Surgery
Lauritzson, Anna
Atroshi, Isam
Collagenase injections for Dupuytren's disease: prospective cohort study assessing 2-year treatment effect durability
title Collagenase injections for Dupuytren's disease: prospective cohort study assessing 2-year treatment effect durability
title_full Collagenase injections for Dupuytren's disease: prospective cohort study assessing 2-year treatment effect durability
title_fullStr Collagenase injections for Dupuytren's disease: prospective cohort study assessing 2-year treatment effect durability
title_full_unstemmed Collagenase injections for Dupuytren's disease: prospective cohort study assessing 2-year treatment effect durability
title_short Collagenase injections for Dupuytren's disease: prospective cohort study assessing 2-year treatment effect durability
title_sort collagenase injections for dupuytren's disease: prospective cohort study assessing 2-year treatment effect durability
topic Surgery
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5353323/
https://www.ncbi.nlm.nih.gov/pubmed/28298365
http://dx.doi.org/10.1136/bmjopen-2016-012943
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