Coupon Accepted Successfully!


Dupytren’s Contracture

This is nodular hypertrophy and contracture of superficial plantar fascia (palmar aponeurosis)

  1. Epidemiology & Associations
    1. Autosomal dominant trait most common in north European (esp anglosaxon)
    2. More common in males & prevelance increases with age
    3. Higher incidence in epileptics receiving phenytoin therapy, diabetics, alcoholic cirrhosis, AIDS, pulmonary tuberculosis
  2. Pathology
    1. Proliferation of myofibroblast. Fibrous bands cause flexion deformity of MP and PIP joints and puckering of skin
    2. Ectopic deposits may occur in dorsum of PIP joint (Garrod’s/ knuclde pads), sole of feet (Ledderhose’s disease) and fibrosis of corpus cavernosum (Peyronie’s disease)
  3. Clinical Features
    1. A middle aged man usually complains of nodular thickening of palm.
    2. Flexion contracture most commonly occur at MP joint. >PIP joint> DIP joint
    3. Ring finger is most commonly involved> little finger> thumb and index finger
    4. PIP contractures soon become irreversible

Description: dupuytrens_illustrationLandscape

Description: images (12)

Garrod’s/ knuclde pads

Ledderhose’s disease

  1. Treatment
    1. Primary indication of surgery is fixed contracture of >300 at MP joint or >150 contracture at PIP joint.
    2. Surgery does not cure the disease, it only partially corrects the deformity
    3. The goal of surgical release is to achieve region fasciectomy or subtotal palmar fasciectomy that will allow maximal untethered joint motion. Complete fasciectomy is unnecessary. Closure may be done by Z plasty secondary intention or skin grafting.
    4. Severe or recurrent PIP joint disease may need arthrodesis.

Test Your Skills Now!
Take a Quiz now
Reviewer Name