A study of the repeatability of the diagnosis of Dupuytren's contracture and its prevalence in the grampian region

Abstract

200 consecutive geriatric patients over 60 years of age (100 men and 100 women) were examined for signs of Dupuytren's contracture and questioned about certain risk factors thought to be associated with the disease. Each patient was examined, independently, by two orthopaedic surgeons. The diagnosis of Dupuytren's contracture was established by the finding of a thickening in the palm fixed to the palmar fascia as a nodule or band. However each patient was also examined for skin tethering, flexion contractures of digits and knuckle pads. The results were then analysed and a Kappa test performed on the data to assess the inter-observer variability in eliciting the signs of Dupuytren's contracture. Using the Kappa test agreement between the two observers was found to be, on average, 1.0 for observing flexion contractures, 0.8 for observing skin tethering, 0.7 for observing palmar nodules and 0.7 for observing knuckle pads. The two observers both made the diagnosis of Dupuytren's contracture in 21% of women and 39% of men. These figures are high compared with previously published data from other centres and confirm the locally held belief that Dupuytren's contracture is particularly prevalent in North-east Scotland.