Primary Proximo-Distal Arthrodesis for Severe Dupuytren's Contracture of the Little Finger: A Prospective Cohort Study.

Abstract

Advanced Dupuytren's contracture of the little finger is challenging due to irreversible soft tissue shortening. Conventional options such as limited fasciectomy or dermofasciectomy often yield limited function and high recurrence. Shortening arthrodesis of the proximal interphalangeal joint is usually a salvage procedure; its role as primary treatment is underexplored. This prospective single-center study (2019-2024) included patients with severe (Tubiana stage III-IV) little finger contracture treated with primary proximo-distal interphalangeal arthrodesis (PDIP) plus limited fasciectomy. Outcomes ≥1 year postoperatively included metacarpophalangeal range of motion, grip strength, Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), visual analog scale (VAS) pain, bone fusion, complications, and recurrence. Twelve patients were included. The mean preoperative contracture was 148°. At follow-up, mean metacarpophalangeal flexion was 99°, and full adduction was restored in 9 of 12 cases. All achieved radiographic fusion, with 42% fused by 6 to 8 weeks and all by 12 weeks. Mean QuickDASH improved from 21 to 5 (<i>P</i> = .004); median VAS pain decreased from 1 to 0 (<i>P</i> = .09). Complications were limited to 1 superficial infection, 1 early recurrence, and 1 adjacent-digit contracture. Primary PDIP arthrodesis with limited fasciectomy is a safe, effective first-line option for advanced little finger Dupuytren's contracture, providing reliable correction, solid fusion, and functional recovery in a single stage.