Progression of Dupuytren's contracture: a randomized controlled trial comparing surgery, needle fasciotomy, and collagenase injection.

Abstract

Dupuytren's contracture can be treated by surgery, needle fasciotomy, or collagenase injection, but how these treatments affect disease progression in both treated and untreated fingers is poorly understood. This study aimed to compare the progression of Dupuytren's contracture across these three treatments over a two-year follow-up and identify patients at highest risk for progression and retreatment. This finger-level analysis used data from the DupuytrEn Treatment EffeCtiveness randomized controlled Trial (DETECT), including 302 participants with 423 initially treated fingers. Progression was defined as an increase in contracture angle between three months and two years post-treatment. Analyses included treated, adjacent untreated, and all untreated fingers. We used linear regression models to identify risk factors for progression and retreatment. Of the participants, 279/302 (92%) completed three-month, and 274/302 (91%) two-year contracture measurements. In treated fingers, surgery resulted in less progression than needle fasciotomy (mean difference 9.7°; 95% confidence interval 3.7 to 16) and collagenase injection (mean difference 6.0°; 95% confidence interval 0.1 to 12), and fewer retreatments. No between-group differences were observed in adjacent untreated or all untreated fingers. Younger age at treatment, smoking, dominantly affected proximal interphalangeal joint, and involvement of the little finger were associated with increased risk of progression or retreatment. Surgery offers more durable results in treated fingers compared to percutaneous methods, though progression and retreatment rates in untreated fingers are similar across all treatment groups. Patients at higher risk for progression, that is, young smokers with affected little fingers, may benefit most from surgery.