Treatment of Dupuytren's Disease of the Proximal Interphalangeal Joint: A Systematic Review and Network Meta-analysis.
Selcen S Yuksel, Carly Schanock, David D Rivedal
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In 30 seconds
This systematic review and network meta-analysis assessed treatments for Dupuytren’s disease affecting the proximal interphalangeal joint in adults, including 19 randomized controlled trials. Limited fasciectomy produced significantly lower total passive extension deficit than collagenase injection or percutaneous needle fasciotomy in both the short term (1-12 weeks) and long term (>2 years), and had the lowest long-term recurrence rates among these operative approaches. Collagenase improved clinical outcomes compared with placebo, while adding triamcinolone to needle fasciotomy improved contracture correction compared with fasciotomy alone. The authors noted that further randomized trials are needed.
Key findings
- Limited fasciectomy significantly reduced total passive extension deficit versus collagenase injection and percutaneous needle fasciotomy at 1-12 weeks and >2 years.
- Limited fasciectomy had the lowest long-term recurrence rates compared with collagenase injection and percutaneous needle fasciotomy.
- Collagenase improved clinical outcomes versus placebo; triamcinolone plus needle fasciotomy corrected contracture better than needle fasciotomy alone.
- Splinting, manipulation timing after collagenase, dermofasciectomy, and limited fasciectomy incision type did not affect correction or recurrence.
Why it matters
PIPJ Dupuytren’s disease can be difficult to correct, and treatment outcomes vary. These pooled comparisons suggest that limited fasciectomy may offer more durable correction and lower recurrence than less invasive alternatives, while also identifying adjuncts and procedural variations that did not show an impact on outcomes. The findings help frame treatment discussions, but the evidence base remains in need of further direct comparisons.
What to keep in mind
The authors state that more randomized controlled trials are needed to compare treatment techniques effectively.