The Orthobullets Podcast Hand⎪Dupuytren's Disease
Oct 18, 2023
Dupuytren's disease takes center stage, exploring its epidemiology and risk factors like age and genetics. The role of myofibroblasts and various growth factors in the disease’s pathophysiology is fascinating. Clinical presentations, surgical risks, and nonoperative treatment options, such as needle aponeurotomy, are thoroughly examined. Listeners learn about the intricacies of surgical techniques and the factors predicting recurrence. The podcast also quizzes listeners, adding an engaging twist to the complex topics!
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Needle Aponeurotomy Indications
- Consider percutaneous needle aponeurotomy in-office with a 22–25 gauge needle for elderly or comorbid patients and mild MCP-predominant contractures.
- Expect higher recurrence and less improvement than open partial fasciectomy, especially for PIP disease.
Surgical Indications And Postop Care
- Indicate surgical fasciectomy for MCP contracture >30° or any PIP flexion contracture affecting function.
- Start early active ROM on postoperative day 5–7 and use nighttime extension splinting to reduce stiffness.
Surgical Technique Tradeoffs
- Total palmar fasciectomy removes non-diseased fascia but raises complications without improving recurrence.
- The open-palm (McCash) technique lowers hematoma risk but prolongs healing and may increase recurrence versus covered closures.