A 65-year-old alcoholic suffering from diabetes has a flexion deformity of the right little linger over the metacarpophalangeal joint of around 15 degrees. The ideal management would be:
Ans. a. Observation (Ref: Campbell s Orthopaedics U/e p4273)A 65-year-old alcoholic suffering from diabetes has a flexion deformity' of the right little finger over the metacarpophalangeal joint of around 15 degrees. Diagnosis of this patient is Dupuytren s contracture. The ideal management would be observation."Dupuytren's contracture: In the absence of contractures, treatment usually is not indicated because nodules and cords usually are painless. Proximal interphalangeal joint and metacarpophalangeal joint contractures of 15a and 3 (P or more, respectively, usually are disabling and may warrant surgical intervention. Campbells Orthopaedics 11/e p4273"Surgery is indicated in Dupuytren \ contracture when the deformity is disabling, when deformity at MCP joint is >30" or PIP joint >15". "Dupuytren's Contracture* Dupuytren's contracture is nodular hypertrophy and contracture of superficial palmar fascia (palmar aponeurosis).* More common in males, age 40-60 years0* Bilateral in 45% cases but involvement is asymmetricalAssociations:* Higher incidence in epileptics receiving phenytoin therapy, diabetics, alcoholic cirrhosis, AIDS, pulmonary tuberculosisClinical Features:* A middle aged man usually complains of nodular thickening of palm* Flexion contracture most commonly occur at metacarpophalangeal joint >PIP joint >DIP joint0* MC finger involved: Ring finger0 > Little finger > Thumb and index finger* PIP contractures soon becomes irreversibleTreatment:* In the absence of contractures, treatment usually is not indicated because nodules and cords are painless0.* Patients with slowly progressive, non-disabling contractures should be examined periodically, perhaps every 3 months0,* Primary indication for surgery is fixed contracture of >3(Pat MP joint or >15 at PIP joint.* Surgery does not cure the disease, it only partially corrects the deformity and recurrences are common.* The goal of surgical release is to achieve regional fasciectomy that will allow maximal untethered joint motion.Complete fasciectomy is unnecessary0.Surgical Procedures used in Dupuytren's Contracture* Subcutaneous fasciectomy* Partial (selective) fasciectomy* Complete fasciectomy* Fasciectomy with skin grafting* Amputation* Resection and arthrodesis of PIP
Observation
Percutaneous fasciotomy
Partial (selective) fasciectomy
Complete fasciectomy
Bone