The following lesions may be associated with Dupuytren’s, lesions in medial plantar fascia in 5 percent and plastic indurations of penis (3%).
Exact cause isn’t known but could also be due to:
• Trauma of chronic repetitive in nature.
• Occupational, seen in people employed in rock drilling due to the vibrations of the machine.
• Males—10 times more common in males.
• Whites are affected more than blacks.
• Frequent and severe in epileptics and alcoholics (42%).
• Onset is usually less than 40 years of age.
Nodules and cords develop due to fibroplasias and hypertrophy of already existing fibers of palmar fascia on its ulnar border.
Usually begins with ring finger at the distal palmar crease and later involves little finger. Flexion of MCP and PIP joints occur. Discomfort is rare, itching or occasional pain over the nodules may be present.
Prognosis: Poor prognostic facts
• Hereditary: In patients with family history, the lesion progresses fast. Hence, heredity is a poor prognostic factor.
• Sex: In women it begins late and progresses slowly.
• Alcoholics or epileptics: Severe, rapid and recurs.
• Behavior of the disease in the past.
Do you know the actual structures involved in Dupuytren’s contracture?
• Palmar fascial (few fibers).
• The pretendinous bands.
• The superficial transverse ligament.
• The spiral band.
• The natatory ligament.
• The lateral digital sheet.
• The Grasym’s ligament.
• The Cleland’s ligament.
Observation: Consists of no treatment with observation being done at every three months interval.
Radiotherapy: It is given only during early fibroblastic phase.
Surgery: It is the best-known treatment and is delayed until actual contractures develop. A procedure chosen it depends upon the degree of contractures, age, occupation, status of the palmar skin, presence or absence of arthritis of the finger joints, etc. More severe the involvement, more extensive is the surgery.
Subcutaneous fasciotomy: This is preferred in elderly, arthritis patients and if the general condition is poor. Results are good when lesion is mature than diffuse. It may be used as a preliminary step to fasciectomy. This procedure has a 72 percent recurrence rate.
Partial selective fasciectomy: This is indicated only when the ulnar two fingers are involved. This is a commonly done procedure, morbidity is less and is associated with less complications. Recurrence rate is 50 percent, needs another surgery in 15 percent of the cases.
Complete fasciectomy: This is rarely done and is associated with haematoma, joint stiffness, delayed healing and recurrence.
Fasciectomy with skin grafting: This is done in young people with epilepsy, alcoholism, and in cases of recurrence after excision. Amputation may be considered if flexion contractures of PIP joint are very severe. Resection and arthrodesis is indicated for severe contractures of the PIP joint. This is better than amputation as it prevents amputation neuroma.