Early outcomes of a sequential series of 144 patients with Dupuytren's contracture treated by collagenase injection using an increased dose, multi-cord technique.

Abstract

Collagenase clostridium histolyticum is the first and only United States Food and Drug Association approved nonsurgical treatment for patients with a palpable Dupuytren's contracture cord. However, the Food and Drug Association has only approved injection of 0.58 mg of this enzyme into one palpable Dupuytren's contracture cord at a time. This review reports on the early outcome of 144 patients treated with the entire bottle of enzyme, approximately 0.78 mg, along with use of a novel slow intracord multi-cord technique. Use of 0.78 mg of enzyme, with the slow intracord multi-cord technique is safe and allows one to inject multiple Dupuytren's contracture cords at one setting. Correction at metacarpophalangeal and proximal interphalangeal joints, taken individually, are comparable with the Collagenase Option for the Reduction of Dupuytren's studies at 43° and 33°, respectively, however due to the multi-cord injection, we achieved 94° average immediate and 76° average final combined metacarpophalangeal and proximal interphalangeal contracture releases per bottle of enzyme. Implementation of the slow intracord multi-cord technique has the potential to improve current treatment for Dupuytren's contracture with resultant significant healthcare savings.