Effects of Collagenase Injection and Surgical Fasciectomy for People with Dupuytren Disease: A Critically Appraised Topic
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Presenter(s)
Silvia Parisi
Abstract
Clinical Scenario: Dupuytren’s disease is caused by thickening of the fascia in the palm of the hands that can lead to disability to use them. Minimal research has been published on effective treatments for Dupuytren’s disease. Common treatments include collagenase injection and surgical fasciectomy. The purpose of this critical appraisal is to compare these two interventions to determine which is more effective for long term management of Dupuytren’s disease.
Focused Clinical Question: In Dupuytren’s Disease, is collagenase injection or surgical fasciectomy more effective preventing contracture long term?
Search Strategy: PubMed database was used to find articles with the following search terms: Dupuytren Disease, Dupuytren Disease’s treatments, Collagenase injection, surgical fasciectomy in Dupuytren Disease. The inclusion criteria were studies with at least 2 year follow up that evaluated adults aged 18 or older with one or more contractures in different joints of the hands. The exclusion criteria were (2) studies with a follow up less than two years. Seven studies were included.
Evidence Quality Assessment: PEDro score were 4/10 to 8/10. Oxford Level of Evidence was level 2.
Results and Summary of Search: Surgical fasciectomy was more effective in providing short-term relief than collagenase injections (p=0.014) in 1 article. 4 articles stated that the disease might reoccur despite surgical fasciectomy and collagenase injections were used (p-values= 0.3, 0.4, 0.014, 0.02) so there was no longer difference between the two treatments.
Strengths of the studies were that both the patients and the assessors were blinded. Weaknesses of the studies were the high dropout rate and small sample size.
Clinical Bottom Line: Both treatments help patients in short-term with contractures but after years the disease may manifest again. With this review, it is possible to notice that collagenase injection and surgical fasciectomy for the Depuytren’s disease are disappointing in the long-term. The strength of recommendation score (SORT) is a level B
Implications: Both treatments, surgical fasciectomy and collagenase injection are not effective in the long term. For the patients, to be able to use their hands, this can force them to go through both treatments multiple times. This study can show to the patients that even with one of those two treatments, their quality of life will improve temporarily and not forever. This topic should be studied in the future trying to understand if one treatment eliminates the other or if they can be used together to hope for a longer result.
College
College of Nursing & Health Sciences
Department
Health, Exercise & Rehabilitative Sciences
Campus
Winona
First Advisor/Mentor
Nora Kraemer
Presentation Type
Oral Presentation
Format of Presentation or Performance
Pre-Recorded Video
Effects of Collagenase Injection and Surgical Fasciectomy for People with Dupuytren Disease: A Critically Appraised Topic
Clinical Scenario: Dupuytren’s disease is caused by thickening of the fascia in the palm of the hands that can lead to disability to use them. Minimal research has been published on effective treatments for Dupuytren’s disease. Common treatments include collagenase injection and surgical fasciectomy. The purpose of this critical appraisal is to compare these two interventions to determine which is more effective for long term management of Dupuytren’s disease.
Focused Clinical Question: In Dupuytren’s Disease, is collagenase injection or surgical fasciectomy more effective preventing contracture long term?
Search Strategy: PubMed database was used to find articles with the following search terms: Dupuytren Disease, Dupuytren Disease’s treatments, Collagenase injection, surgical fasciectomy in Dupuytren Disease. The inclusion criteria were studies with at least 2 year follow up that evaluated adults aged 18 or older with one or more contractures in different joints of the hands. The exclusion criteria were (2) studies with a follow up less than two years. Seven studies were included.
Evidence Quality Assessment: PEDro score were 4/10 to 8/10. Oxford Level of Evidence was level 2.
Results and Summary of Search: Surgical fasciectomy was more effective in providing short-term relief than collagenase injections (p=0.014) in 1 article. 4 articles stated that the disease might reoccur despite surgical fasciectomy and collagenase injections were used (p-values= 0.3, 0.4, 0.014, 0.02) so there was no longer difference between the two treatments.
Strengths of the studies were that both the patients and the assessors were blinded. Weaknesses of the studies were the high dropout rate and small sample size.
Clinical Bottom Line: Both treatments help patients in short-term with contractures but after years the disease may manifest again. With this review, it is possible to notice that collagenase injection and surgical fasciectomy for the Depuytren’s disease are disappointing in the long-term. The strength of recommendation score (SORT) is a level B
Implications: Both treatments, surgical fasciectomy and collagenase injection are not effective in the long term. For the patients, to be able to use their hands, this can force them to go through both treatments multiple times. This study can show to the patients that even with one of those two treatments, their quality of life will improve temporarily and not forever. This topic should be studied in the future trying to understand if one treatment eliminates the other or if they can be used together to hope for a longer result.
