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The demand for treatment of Dupuytren's disease by a procedure of limited invasiveness and quick recovery is increasing in accordance with aging of the Polish population. Such a demand is fulfilled by different types of fasciotomy (open, percutaneous needle fasciotomy).The aim of the study was to asses the early results of the open fasciotomy in elderly patients.Material and methods. We treated 38 patients (61 fingers) whose mean age was 72 (SD 12) by open fasciotomy; 43 fingers presented stage III Tubiana contracture, 18 stage IV. The pre-operative total passive extension deficit was 123° (78° for stage III group, 111° for stage IV group). All the procedures were performed in outpatient setting. Patients used splint for 5 days, then performed finger - extension exercises and were encouraged to use their hands normally after 1 week.Results. The evaluation of the results was performed 4 weeks post-op. The greatest improvement in both of the groups was noted in MCP joint - 80% and in PIP joint - 48%, this difference is statistically significant. The general improvement ratio was 76%, greater in stage III group - 82% whereas in stage IV group 69%, but this difference was not statistically significant. All of the wounds healed up to 3 weeks, no complications were observed.Conclusion. The open fasciotomy is a recommendable short term treatment in patients of advanced age, suffering from stage III and stage IV of Dupuytren's disease.
Content available remote Early and Long-Term Results Following Surgery for Dupuytren's Disease
The aim of the study was assessment of the early and long-term results following surgery for Dupuytren's disease.Material and methods. In this study the treatment results of 74 patients with Dupuytren's disease were revealed. Patients were treated using fasciotomy, selective fasciectomy, subtotal fasciecotmy and dermofasciectomy. Patients were divided into two groups. Group I (n=35) was examined prospectively 3 times: prior to the surgery, 1 and 3 months after it. Group II (n=39) was examined retrospectively once between 3 to 7 years after the surgery. The examination took into account: occurrence of factors predisposing the disease to reappear (Dupuytren's diathesis), hand's function in patient's subjective opinion evaluated with DASH questionnaire and goniometrical measurement of the contracture.Results. Contracture reduction was observed in group I in 94% of patients. The average Total Loss of Extension before surgery was 123.85°, 3 months after operation - 54.51°. In group II the average Total Loss of Extension was 42.63°. Average DASH score in group 1 before surgery was 17.5. One month after the surgery a significant aggravation was observed (average score - 29.95). Three months after the surgery, there was an improvement and DASH score reduced to 15.02. The average DASH score in group II was 4.34. In both groups there was a correlation between patients' age and hand's function. Elder patients evaluated hand's function as better after the surgery. Recurrence of the disease was observed in 17% of patients in group 1 and 33% of patients in group II. Occurrence of predisposing factors (diathesis) increased probability of recurrence in group II. Significant differences in treatment results were not notified because of the surgery technique.Conclusions. This study reveals numerous problems with operative treatment of Dupuytren's disease: faint improvement of hand's function in primary months after surgery, large percentage of recurrences of the disease, a small number of patients with extension of fingers obtained as an outcome of the surgery.
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