Dupuytren's contracture

Question 1

What is Dupuytren’s contracture?

Answer 1

This is the thickening and contracture of the subdermal fascia leading to a fixed flexion deformity of the fingers

Question 2

What are some possible causes of Dupuytren’s contracture?

Answer 2

• Genetics
• Diabetes melitus
• Alcohol/Liver cirrhosis
• Smoking
• Anti-epileptic medication
• Possible trauma

Question 3

What are some genetic factors that predispose to Dupuytren’s contracture?

Answer 3

Autosomal dominant mutation
Common in Northern Europe
Males

Question 4

Describe the pathophysiology of Dupuytren’s contracture

Answer 4

Excessive myofibroblast proliferation
+
Altered collagen (III) matrix composition
=>
Thickened and contracted palmar fascia
=>
Fixed flexion deformity

Question 5

How does Dupuytren’s contracture present?

Answer 5

Painless condition with gradual progression
Contraction of the ring finger and pinkie most common
Starts with pit and nodule formation

Question 6

What are some further disease presentations found in Dupuytren’s diathesis?

Answer 6

Lederhosen’s
Pyronie’s

Question 7

What is Lederhosen’s presentation?

Answer 7

Superficial fibromatosis of the foot

Question 8

What is Pyronie’s presentation?

Answer 8

Superficial fibromatosis of the penis

Question 9

What clinical examination is used in Dupuytren’s contracture?

Answer 9

Table top test - Patient cannot flatten hand on a tabletop

Question 10

How can Dupuytren’s contracture be managed conservatively?

Answer 10

Hand stretches
Activity modification

Question 11

What are some surgical management options in Dupuytrens contracture?

Answer 11

• Segmental fasciotomy
• Fasciectomy
• Dermofasciectomy
• Amputation

Question 12

What are some new treatments available for Dupuytren’s contracture?

Answer 12

Collagenous injection
Percutaneous needle fasciotomy