Injectable collagenase Clostridium histolyticum as a nonsurgical treatment for Dupuytren's disease

Abstract

Objective: Nonsurgical treatment of Dupuytren's disease using collagenase Clostridium histolyticum (CCH).

Indications: Metacarpophalangeal (MP) joint (20-100°) and proximal interphalangeal (PIP) joint (20-80°) contractures.

Contraindications: Pregnancy, previous hypersensitivity to collagenase or excipients, anticoagulant use within 7 days prior to treatment.

Injection technique: CCH injected directly into the Dupuytren's cord weakening the contracted cord. After injection, the patient returns the following day to allow CCH to lyse the collagen within the cord. An extension force is then applied to the involved finger to disrupt the weakened cord.

Postmanipulation management: Use of extension splint at night, movement instructions during the day.

Results: A total of 120 patients (107 men; 13 women; mean age 62 years, range 30-84 years) were treated. In 49% the little finger, in 44% the ring finger, in 4% the middle finger, and in 3% the index finger was treated. Full release was achieved in 71%, partial release in 26%, and no change in 3% of patients. The median pretreatment contracture for the MP joint was 37° (range 25-100°) and PIP joint 51° (range 30-97°). At 12 months, the mean contracture for the MP joint was 9° (range 0-25°) and for the PIP joint 21° (range 10-36°). Adverse events observed in 96% of patients for 3 months . No tendon ruptures, anaphylactic reactions, or nerve or ligament injuries observed.

Keywords: Collagenase treatment; Dupuytren contracture; Fingers; Hand; Non surgical treatment.