Dupuytren’s Contracture: A Comprehensive Update on Management Strategies, Ranging from Conservative Observation and Corticosteroid Injections to Minimally Invasive Needle Aponeurotomy and Collagenase Injection, and the Role of Limited Fasciectomy for Advanced Contractures
Dupuytren’s Contracture is a progressive myofibroblastic disease affecting the palmar fascia of the hand, leading to the formation of painless cords that eventually cause debilitating flexion contracture of the fingers, most commonly the ring and small digits. Treatment strategies for this condition are highly varied and tailored to the stage and severity of the contracture. Conservative management, often involving observation for stable disease, or corticosteroid injections for painful nodules, is appropriate for early stages. ****
For more advanced contractures, minimally invasive options like Needle Aponeurotomy (NA) and Collagenase Clostridium Histolyticum injection have become popular due to their high efficacy and lower invasiveness compared to traditional surgery. NA physically breaks up the cord with a needle, while collagenase, an enzyme, dissolves the collagen cord. Surgical options, such as Limited Fasciectomy, are reserved for more severe or recurrent cases. A critical point for discussion is the high rate of disease recurrence associated with all treatments, prompting debate on which intervention offers the best long-term outcome versus the most favorable complication profile, and whether a combination of therapies might offer a more durable solution.