Comparing Treatment Approaches for Dupuytren Contracture: Percutaneous Needle Fasciotomy With and Without Corticosteroids.

Abstract

Percutaneous needle fasciotomy (PNF) is a standard treatment for Dupuytren contracture. In some instances, clinicians administer intraoperative corticosteroids (ICS) and/or postoperative corticosteroids (PCS) alongside PNF to improve outcomes. However, few studies have systematically investigated the efficacy of ICS and/or PCS as adjuvant therapies to PNF. The purpose of this study was to review clinical outcomes between PNF alone and PNF with corticosteroid use in the treatment of Dupuytren contracture. A systematic review was done in February 2024 using SCOPUS and OVID, including all level I-IV studies that reported outcomes of PNF, PNF/ICS, and PNF/PCS. Outcomes of interest included range-of-motion (ROM) improvement at the distal interphalangeal, proximal interphalangeal , and metacarpophalangeal joints of the affected digit, as well as complication rates. Secondary outcomes included Quick Disabilities of the Arm, Shoulder, and Hand scores and Unité Rhumatologique des Affections de la Main scores. Twenty-six studies were included (3,203 PNF patients, 840 PNF/ICS, 81 PNF/PCS, and 921 receiving general corticosteroid use). Twenty-one studies examined PNF alone, six examined PNF/ICS, and three studied PNF/PCS. In studies directly comparing groups, corticosteroid use was associated with greater ROM at final follow-up. PNF alone demonstrated the largest distal interphalangeal ROM gains and superior Disabilities of Arm, Shoulder, and Hand and Unité Rhumatologique des Affections de la Main scores but had the highest and most variable complication rates. PNF/ICS showed the greatest improvement in total joint ROM, while PNF/PCS yielded the largest metacarpal phalangeal and proximal interphalangeal ROM gains. General corticosteroid use showed superior ROM across all joints compared with PNF alone. Corticosteroid use alongside PNF improves objective ROM outcomes and reduces complication rates compared with PNF alone. However, subjective improvements favored PNF without corticosteroids. These findings suggest that corticosteroids may enhance functional outcomes while preserving the minimally invasive benefits of PNF.