Surgery superior to needle fasciotomy, collagenase for Dupuytren contracture

Treatment with surgery, needle fasciotomy, or collagenase injection results in similar outcomes among patients with Dupuytren contracture, reports a study. At 2 years, however, success rates are maintained with surgery but lower with the other two strategies despite retreatments.

Three hundred two persons with treatment-naïve Dupuytren contracture (angle <135 °) were included in this multicentre, randomized, outcome assessor-blinded, superiority trial across six public hospitals in Finland. Of the participants, 101 underwent surgery, 101 had needle fasciotomy, and 100 received collagenase injection.

Success rate, the primary outcome, was defined as >50-percent contracture release and patients reaching the acceptable symptom state. Secondary outcomes were as follows: pain, hand function, quality of life, patient satisfaction, residual contracture angle, finger flexion, retreatment risk, and serious adverse events.

Of the participants, 292 (97 percent) completed the 3-month follow-up and 284 (94 percent) the 2-year follow-up. At 3 months, success rates were similar across the treatment strategies (surgery: 71 percent, 95 percent confidence interval [CI], 62‒80; needle fasciotomy: 73 percent, 95 percent CI, 64‒82; collagenase: 73 percent, 95 percent CI, 64‒82).

At 2 years, however, surgery demonstrated superiority over both needle fasciotomy (78 percent vs 50 percent; adjusted risk difference [aRD], 0.30, 95 percent CI, 0.17‒0.43) and collagenase (78 percent vs 65 percent; aRD, 0.13, 95 percent CI, 0.01‒0.26) in terms of the primary outcome.

The study was limited by the nonblinding of participants.

“Surgery, needle fasciotomy, and collagenase injection are used to treat Dupuytren contracture,” the researchers said. “The treatment decision requires balancing initial morbidity and costs of surgery against its potential long-term benefits over needle fasciotomy and collagenase.”