Purpose
To compare flexion deformity at 6 months in patients with Dupuytren contracture who
had percutaneous needle aponeurotomy (PNA) combined with a series of triamcinolone
acetonide (TA) injections to that of patients who had PNA alone.
Methods
Forty-seven patients with Dupuytren disease who were candidates for PNA (at least
1 contracture of at least 20°) participated in the study. Patients were randomized
either to receive TA injections immediately following and 6 weeks and 3 months after
the procedure or to receive no injections. Injections were administered into cords.
The number of injections and the amount of TA per injection was determined based on
the number of digits involved and the cord size. All subjects returned for 3 follow-up
visits after the procedure, and contractures were measured using a goniometer. Change
in total active extension deficit (TAED) was analyzed using a repeated measures analysis
of variance to assess for differences between groups, time points, and interaction
between group and time point. Descriptive statistics were calculated for all variables
of interest. Continuous measures were summarized using means and standard deviations.
Results
There was no significant difference in TAED between groups before cord aponeurotomy.
Correction at 6 months was 87% of preoperative TAED for the TA group versus 64% for
the control group. This difference was statistically significant. The amount of TA
administered did not correlate with TAED improvement.
Conclusions
The study group who received TA in combination with PNA experienced a significantly
greater degree of correction of flexion deformity at 6 months than those who had PNA
alone.
Type of study/level of evidence
Therapeutic II.
Key words
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Article info
Publication history
Published online: May 28, 2012
Accepted:
April 18,
2012
Received:
October 28,
2011
Footnotes
Funding support was provided by the Canadian Society of Plastic Surgeons.
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2012 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Steroid Injections in Combination With Needle Aponeurotomy as a Treatment Method for Dupuytren Disease: Suggestions for Increasing the Research EvidenceJournal of Hand SurgeryVol. 37Issue 11
- PreviewWe read with great interest McMillan and Binhammer's1 article about steroid injections in combination with needle aponeurotomy as a treatment method for Dupuytren disease. As the authors stated, needle aponeurotomy is minimally invasive, but its recurrence rate is higher than that of more invasive treatments.2 We congratulate the authors for the interesting research they performed, because at first glance this combination of steroid injections with needle aponeurotomy seems to be promising in decreasing the recurrence rate.
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