Dupuytren Disease. Júlio André, Fernando Cruz, Mª José Maio

8/6/2019 Dupuytren Disease. Jlio Andr, Fernando Cruz, M Jos Maio

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Dupuytren Disease

Pedro Simas

Leonor Fernandes

Teresa Marques

Jlio Andr Almeida

Hospital Garcia de Orta - Almada

Director - Dr. Craveiro Lopes


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Introduction

1st described Guillaume Dupuytren (1831)

Palmar Fibromatosis

Incidence male related

Prevalence northern Europe

Risk factors diabetes, alcohol, tobacco

PIP contracture 4th and 5th fingers


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PIP Contracture

Amputation ofmedial and distal phalanx

Ressection ofmedial phalange Arthrodesis

Open

Fixation with Kirschner wire

Joint replacement???

Persistent deformity after distal selective fascectomy


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PIP Contracture

Phalanx or finger mostly 5th finger

Severe functional deficit or vascular injury

Recurrent disease

Amputation of the medial and distal phalange


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PIP Contracture

Open or fixation with K-wire

Good functional outcome

DIP extension Pseudoboutonnire

Arthrodesis


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Material and Methods

2000-2006

119 patients operated

102 patients evaluated 120 hands 196 rays

7 PIP arthrodesis

16 complications

4 reoperated


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Objectives

Evaluate the influence of comorbidities

diabetes

Evaluate the influence of tobacco and alcohol in

the prevalence and evolution of the disease

Evaluate the quality of treatment


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Results

Gender

M:F = 6:1

Age of beginning of the disease

Average interval between beginning the disease and surgery 10,78 years


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Results

Operated rays

Bilateral cases 17 patients


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Results

Tobacco Alcohol

Positive family history 18%


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Results Comorbidities Hand pathology


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Results

Complications

Sudecks athrophy 3

Dysesthesia 9

Infection 3

Hypertrophic scars 1

Skin cicatrization problems 15


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Results

Patients satisfaction

Exc

elle

nt

Goo

dP

oor

Fair


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Analysis of Results

Diabetes

Complications

- Diabetes: 46% and No-diabetes: 18%

Recurrences

- Diabetes: 30% and No-diabetes: 17%

Tubiana Classification Post-operative

Diabetes 1,14 (0-3)No-diabetes 0,67 (0-3)

p


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Analysis of Results

AlcoholPost-operative

Alcohol 0,91 (0-3)No-alcohol 0,59 (0-3)

Tubiana Classification

Complications

- Alcohol: 24% and No-alcohol: 33%

Recurrences

- Alcohol: 19% and No-alcohol: 21%

p>0,01

p>0,01


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Tubiana Classification Post-operative

Smoking 0,83 (0-3)Non-smoking 0,88 (0-3)

Analysis of Results

Tobacco

Complications

- Smoking: 28% and Non-smoking: 26%

Recurrences

- Smoking: 18% and Non-smoking: 22%

p>0,01

p>0,01


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PIP arthrodesis

Persistent deformity uncorrected by distal fascectomy

Arthrodesis fixation with Kirschner wires

6 patients/ 7 raysGender Diabetes Tobacco Ray Recurrency Satisfaction

M Yes Yes R5 Yes Good

F Yes No R5 Yes Good

M No No R4,R5 No Fair

M No Yes R5 No Fair

M No Yes R5 No Bad

M No No R5 No Deceased

Analysis of Results

PIP


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Conclusions

Excellent and good results: 74%

Diabetes related to disease recurrence and complications

Tobacco and Alcohol not related? ( other studies)

PIP arthrodesis small n of patients

PIP arthrodesis better results in recurrent disease?


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OBRIGADO!

Documents

Dupuytren Disease. Júlio André, Fernando Cruz, Mª José Maio