Assessing the Effect of Time from Injection of Collagenase to Manipulation on Success Rates in Dupuytren Disease

Purushottam Nagarkar; Nirbhay S Jain; Meaghan L Barr; Cathy Tang; Dong Lee; Irene Chang; Michael R Delong; Prosper Benhaim

doi:10.1016/j.jhsa.2023.07.015

Assessing the Effect of Time from Injection of Collagenase to Manipulation on Success Rates in Dupuytren Disease

J Hand Surg Am. 2023 Aug 21:S0363-5023(23)00390-8. doi: 10.1016/j.jhsa.2023.07.015. Online ahead of print.

Authors

Purushottam Nagarkar¹, Nirbhay S Jain², Meaghan L Barr², Cathy Tang³, Dong Lee⁴, Irene Chang⁵, Michael R Delong², Prosper Benhaim⁶

Affiliations

¹ Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
² Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, CA.
³ Division of Plastic and Reconstructive Surgery, University of California, Irvine, CA.
⁴ Department of Orthopaedic Surgery, University of California, Los Angeles, CA.
⁵ Case Western Reserve University School of Medicine, Cleveland, OH.
⁶ Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, CA; Department of Orthopaedic Surgery, University of California, Los Angeles, CA. Electronic address: pbenhaim@mednet.ucla.edu.

PMID: 37610395
DOI: 10.1016/j.jhsa.2023.07.015

Abstract

Purpose: Dupuytren disease can be managed with an injection of collagenase Clostridium histolyticum enzyme followed by manual manipulation. Although the recommended time from injection to manipulation is 24-72 hours, patient and physician schedules may not accommodate this time frame. Therefore, we sought to study the impact of time from injection to manipulation on outcomes and complications of collagenase injection.

Methods: We performed a review of 309 patients who underwent an injection of collagenase Clostridium histolyticum for Dupuytren disease with manipulation at two, five, or seven days after injection. We compared preinjection and postinjection contracture angles as well as frequency of skin tears and tendon ruptures.

Results: Of the 309 patients, 207 underwent manipulation at two days, 32 at five days, and 70 at seven days. Patients had similar preinjection contracture angles. All patients demonstrated improvement in contracture after manipulation. Rates of skin tears and tendon ruptures were similar in all three groups. Significant predictors of complications included number of cords injected and history of previous collagenase injection, but not history of previous Dupuytren diagnosis.

Conclusions: Although collagenase injection for Dupuytren disease is typically performed with plans for manipulation at 24-72 hours, postinjection manipulation could be performed as late as seven days without adversely affecting the frequency of skin and tendon complications.

Type of study/level of evidence: Prognostic IV.

Keywords: Collagenase; Dupuytren Disease; practice management.