Craig Dent, Nino Coutelle, Meera Gill, Peter Simon, Michael Doarn, Jason Nydick
{"title":"Clinical Effectiveness of an Orthosis After Collagenase Clostridium Histolyticum Injection for Dupuytren Contracture.","authors":"Craig Dent, Nino Coutelle, Meera Gill, Peter Simon, Michael Doarn, Jason Nydick","doi":"10.1016/j.jhsa.2025.01.023","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>Dupuytren contracture is a fibroproliferative disorder forming fascial cords in the hand. Collagenase clostridium histolyticum (CCH) is an alternative treatment to surgery. Current recommendations include nighttime extension orthosis after CCH for 4 months. Our purpose was to evaluate the effectiveness of night orthosis following CCH treatment.</p><p><strong>Methods: </strong>The study was a prospective, randomized, controlled trial at a single institution. Patients with Dupuytren contracture of one or more digits treated with CCH from May 2021 to 2023 were screened. Eighty patients were enrolled and randomized between groups (a nighttime orthosis or no nighttime orthosis). The orthosis group was instructed to wear an extension orthosis nightly until 4 months. Baseline, postmanipulation, and 1-month, and 4-month flexion contractures were collected. QuickDASH (Disabilities of the Arm, Shoulder, and Hand) and splint compliance surveys were collected at 1 and 4 months. Skin tears and adverse events were recorded.</p><p><strong>Results: </strong>There were 39 orthosis patients, and 40 nonorthosis patients who received CCH treatment. A total of 119 joints were treated, including 66 metacarpophalangeal (MCP) and 53 proximal interphalangeal (PIP) joints. Seventy-six and 69 patients completed 1- and 4-month follow-up. Baseline characteristics were similar between two groups. Mean baseline flexion contracture for all joints was 48° and 55° for the orthosis and nonorthosis groups, respectively. The orthosis group had significantly lower residual contracture at 4 months (11° vs 20°). No difference was found at any time for MCP joints. PIP joints in the orthosis group had significantly lower contracture at 1 and 4 months (13° vs 28°; 19° vs 36°). Reported compliance with orthosis was 79% at least \"Most of the Time\" at 1 month and 52% at least \"Half of the Time\" at 4 months.</p><p><strong>Conclusions: </strong>Our study suggests greater benefit of night orthosis for PIP joint contractures. We recommend night orthosis after CCH treatment of PIP joint contractures and optional use for MCP contractures.</p><p><strong>Type of study/level of evidence: </strong>Therapeutic II.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.1000,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Hand Surgery-American Volume","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.jhsa.2025.01.023","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
Abstract
Purpose: Dupuytren contracture is a fibroproliferative disorder forming fascial cords in the hand. Collagenase clostridium histolyticum (CCH) is an alternative treatment to surgery. Current recommendations include nighttime extension orthosis after CCH for 4 months. Our purpose was to evaluate the effectiveness of night orthosis following CCH treatment.
Methods: The study was a prospective, randomized, controlled trial at a single institution. Patients with Dupuytren contracture of one or more digits treated with CCH from May 2021 to 2023 were screened. Eighty patients were enrolled and randomized between groups (a nighttime orthosis or no nighttime orthosis). The orthosis group was instructed to wear an extension orthosis nightly until 4 months. Baseline, postmanipulation, and 1-month, and 4-month flexion contractures were collected. QuickDASH (Disabilities of the Arm, Shoulder, and Hand) and splint compliance surveys were collected at 1 and 4 months. Skin tears and adverse events were recorded.
Results: There were 39 orthosis patients, and 40 nonorthosis patients who received CCH treatment. A total of 119 joints were treated, including 66 metacarpophalangeal (MCP) and 53 proximal interphalangeal (PIP) joints. Seventy-six and 69 patients completed 1- and 4-month follow-up. Baseline characteristics were similar between two groups. Mean baseline flexion contracture for all joints was 48° and 55° for the orthosis and nonorthosis groups, respectively. The orthosis group had significantly lower residual contracture at 4 months (11° vs 20°). No difference was found at any time for MCP joints. PIP joints in the orthosis group had significantly lower contracture at 1 and 4 months (13° vs 28°; 19° vs 36°). Reported compliance with orthosis was 79% at least "Most of the Time" at 1 month and 52% at least "Half of the Time" at 4 months.
Conclusions: Our study suggests greater benefit of night orthosis for PIP joint contractures. We recommend night orthosis after CCH treatment of PIP joint contractures and optional use for MCP contractures.
期刊介绍：
The Journal of Hand Surgery publishes original, peer-reviewed articles related to the pathophysiology, diagnosis, and treatment of diseases and conditions of the upper extremity; these include both clinical and basic science studies, along with case reports. Special features include Review Articles (including Current Concepts and The Hand Surgery Landscape), Reviews of Books and Media, and Letters to the Editor.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
