DUPUYTREN DISEASE
Dupuytren's disease is characterized by fibrotic nodules and bands in the palmar aponeurosis, leading to flexion deformities in the fingers. The etiology is unclear, with higher incidence in Europe. Clinical presentation varies, with treatment options including collagenase injections, needle aponeurotomy, and surgical aponeurectomy.
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DUPUYTREN DISEASE MUDr.Drahom r Palen r, PhD. MUDr.Ivan Hul n
Characteristic Pathologic findings in palmar aponeurosis Fibrotic nodules and bands superficial from tendons and nerovascular structures Secundar flections of MCP a PIP joints 1831 marquise Guillaume Dupuytren (1777-1835)
Ethiology, Pathofysiology Not clear The role of myofibroblasts Higher amount of colagen type I. Luck classification: 1. proliferative fasis 2. involution fasis (usporiadanie v smere ahu) 3. rezidual fasis (acelul rny vzh ad) Nowadays we think it is proliferative and mechanical process. The role of cytikynes stimuls for fibroblasts
Incidence Europe. Kelts China and Africa low incidence Decreasing from north to south of Europe (Viking s disease) Ratio male : female = 7,5 : 1 Incidence is increasing with age Geografic difference (maximum Australia, France, Scotland, Ireland 17% Other parts of body plantar (Ledderhose), IPP
Clinical course Simple classification 1. palmar form 2. fingers form 3. finger-palmar form Tubiana classification N nodules and bands N1 5 degree contracture Stage 1 4 (severe contracture on one finger at least)
Degree of contracture Stage Clinical signs N 0 Nodules and bands N/1 0-5 Mild contracture 1 6-45 2 46-90 3 91-135 4 More than135
Treatment and indications Collagenase Tubiana 1 and 2 Needle aponeurotomy Tubiana 1 and 2, or 3-4 before operation Surgical aponeurectomy Tubiana N, N/1 no treatment Rehabilitation is very important
Treatment N N/1 1 2 3 4 Collagenase ++ ++ Needle aponeurotomy + ++ ++ + + Surgical aponeurectomy + ++ ++ ++ + relative indication ++ highly indicated
Complications Hematoma, infection, digital nerve injury, skin necrosis, hand swelling. Complications total - 19 % Algoneurodystrofic syndroma 10 % (Sudeck syndr.)
