Finger shortening for Dupuytren's disease-induced severe PIP joint flexion contracture of the little finger: A report of two cases

Abstract

When severe proximal interphalangeal (PIP) joint flexion contracture is induced in the little finger by Dupuytren's disease, it interferes with activities of daily living. To extend the little finger, open fasciectomy is selected as a general treatment method. However, postoperative complications have been frequently reported. To solve these problems, finger shortening was undertaken. In this study, we treated two cases of Dupuytren's disease manifesting severe PIP joint flexion contracture of the little finger with finger shortening by proximodistal interphalangeal (PDIP) fusion in which the middle phalanx is resected and the residual distal and proximal phalanges are fused. For flexion contracture of the MP joint, a percutaneous aponeurotomy using an 18G needle was performed to obtain the extended position of the MP joint. Favorable outcomes with high patient satisfaction, including esthetic aspects of retaining the finger with the nail without complication, were achieved. We report this challenging treatment and its discussion.

Keywords: Dupuytren’s disease; Finger shortening; Little finger; Severe PIP joint flexion contracture.

Figure 1

Intraoperative findings. (A) Dupuytren’s disease-induced severe PIP joint flexion contracture of the little finger was observed. (B) A dorsal approach was designed to resect the middle phalanx. (C) The extension position of the little finger was acquired by resection of the middle phalanx. (D and E) After resection of the middle phalanx, articular cartilages distal to the proximal phalanx and proximal to the distal phalanx were removed, and these 2 bones were fixed at the little finger extension position using Break-Away Screw (Acutwist^®, Nihon Medical Next, Osaka Japan) ((D) Macroscopic findings of the little finger after surgery, (E) intraoperative fluoroscopic image).

Figure 2

Clinical findings on the final follow-up (2 years after surgery) in Case 1. (A and B) The little finger extension position set by surgery was acquired without recurrence and the surgery was esthetically highly satisfactory without nail deformation ((A) dorsal side, (B) palmar side).

Figure 3

Clinical findings in Case 2. (A) Dupuytren’s disease-induced severe PIP joint flexion contracture of the little finger was observed before surgery. (B) The little finger extension position set by surgery was acquired without recurrence and the surgery was esthetically highly satisfactory on the final follow-up (2 years after surgery).

Figure 4

Plain radiography on the final follow-up (2 years after surgery). Bone union of the distal and proximal phalanges was confirmed on plain radiography.