How is Palmar fibromatosis (Dupuytren contracture) treated?

Updated: Oct 07, 2019
  • Author: Guy J Petruzzelli, MD, PhD, MBA, FACS; Chief Editor: Gregory Gary Caputy, MD, PhD, FICS  more...
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Collagenase Clostridium histolyticum (CCH) is an injectable treatment for PF that was approved by the FDA in February of 2010 and in the European Union (EU) in 2011. In a 3-year study of 1080 CCH-treated joints, 35% of the joints experienced recurrence. Of these recurrences, an additional intervention was required in 7% of patients.​ [64]  In the 1080 CCH-treated joints, partial correction of 301 joints occurred in the original study. In these, 50% experienced nondurable responses. While treatment failures occurred, adverse effects were rare. In most successfully treated joints, a contracture remained well beneath the threshold for surgical intervention 3 years posttreatment. Recurrence rates in effectively treated joints appeared lower compared with nondurable response rates in partially corrected joints.

A study by Nordenskjöld et al indicated that in collagenase injection treatment for Dupuytren contracture, recurrence is more likely to result following treatment of the proximal interphalangeal joint of the small finger, as well as in the presence of more severe pretreatment contracture and if fasciectomy was previously carried out on the treated finger. [65]

A study by Nayar et al of patients with Dupuytren contracture who were treated with collagenase Clostridium histolyticum (CCH) injection found that contracture in 95% of metacarpophalangeal joints immediately improved from 50° to 1.5°, while in 42% of the proximal interphalangeal joints, improvement from 44° contracture to 16° was seen. At 2-year follow-up, contractures of 17° and 35.5° were observed in the metacarpophalangeal and proximal interphalangeal joints, respectively. [66]

If the decision is made to treat PF, then surgery is the treatment of choice. Mild or moderate disease, it seems, should just be monitored. Patients with a mild Dupuytren contracture and some disability can be monitored for several years without surgical intervention. The criteria for surgical intervention include a metacarpophalangeal joint contracture of greater than 30º or any proximal interphalangeal joint contracture. The surgery entails a fasciectomy.

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