Dupuytrens Contracture

Question 0

Pathophysiology of DC

Answer 0

Small and ring fingers most commonly affected
Tends to present with painless deformity in middle aged men
Unclear: role of micro trauma, unrelated to handedness
Activation of fibroblasts leads to fibrosis

Question 1

What is Dupuytren’s Contracture

Answer 1

Fibroproliferative disease of palmar and digital fascia
Palmar aponeurosis thickens
Does not directly involve the flexor tendons which are deeper
But prevents flexor tendons from working properly
Not painful but may cause functional impairment

Question 2

Clinical presentation

Answer 2

Starts as a firm painless nodule
Some patients have a skin pitting on palm
Some may be associated with thickening of knuckle pads
Progresses with cord formation
Leading to fixed flexion contracture of MCPs and sometimes PIPs

Question 3

Associated with

Answer 3

North European ancestry
Family history
Alcohol consumption
Cigarette smoking
Diabetes
Peyronie's disease
Phenytoin

Question 4

Txt

Answer 4

Many do not require any
Segmental fasciectomy
May require zig zag incision to prevent volar contracture
Post op splinting and physiotherapy

Question 5

Complications of surgery

Answer 5

Infection
Haematoma
Damage to neurovascular bundle
Significant recurrence rate