50 years experience with Dupuytren's contracture in the Erlangen University Hospital--a retrospective analysis of 2919 operated hands from 1956 to 2006

Abstract

Background: Dupuytren's disease (DD) is a hand disorder mainly among the northern population. In contrast it is rare in the mediterranean population. Therefore typical habits and dietetic influences have been discussed as well as genetic predisposition. Still, since the first description by Dupuytren in 1834 only little is known about the etiology and pathogenesis of this disease. Some hints were found for a higher prevalence among people with diabetes, alcohol abuse or smoking. Also, intensive manual work or hand injuries have been discussed to have an influence on DD. To our knowledge this is the largest retrospectively evaluated series of symptomatic patients published to date. The study includes patients from the last 50 years. It was performed to show possible correlations between DD and typical risk factors such as diabetes, alcohol consumption, and smoking.

Methods: We retrospectively analysed all patient records with DD documented between 1956 and 2006 in the Surgical University Hospital in Erlangen. Data acquisition was conducted by reviewing the medical records from 1956 to 2006 including data from all patients who were surgically treated because of DD.

Results: We reviewed 2579 male and 340 female surgically treated patients with DD. More than 80% of the patients were between 40 and 70 years old. In 28.9% only the right hand was effected by DD, in 25.3% only the left hand and in 45.8% both hands. In 10.3% of all Patients suffered from Diabetes mellitus. Statistical analysis revealed no significant correlation between diabetes, alcoholism or smoking on the degree of DD in our patients.

Conclusion: Most data are consistent with previously published results from smaller, comparable retrospective studies with regard to right- or left handedness. We could not confirm a statistically significant correlation of DD with diabetes mellitus, severe alcohol consumption, heavy smoking or epilepsy and the stage of the disease as described in other studies. However, in the whole cohort of our operated patients during the last 50 years the prevalence of the above mentioned risk factors is slightly higher than in the normal population.

Figure 1

Percentage of all patients at time of operation classified in decades divided in men and women. In this figure it is obvious that operation time point in women is one decade later than in men.

Figure 2

Sex ratio men to women classified in decades

Figure 3

Maximum stage of Dupuytren's disease per hand between 1956 and 1987.

Figure 4

Mean stage of Dupuytren's disease in men and women classified in decades.

Figure 5

Mean stage of Dupuytren's disease per Finger in all Patients from the year 1988 to the year 2006.

Figure 6

Erlangen external traction device to correct soft tissue and joint contracture before fasciectomy.

Figure 7

Patient with Cross-Finger-Flap from digit 4 to digit 5 to fill up a skin deficit after correction of the Dupuytren's contracture stage 4 where distraction was not possible.