Arch Hand Microsurg.  2018 Mar;23(1):28-34. 10.12790/ahm.2018.23.1.28.

Ultrasound-Guided Percutaneous Needle Fasciotomy after Steroid Injection for Dupuytren's Contracture

• Yoo JS
• Heo K
• Kim SJ
• Park KH
• Kim JP

• KMID: 2412488
• DOI: http://doi.org/10.12790/ahm.2018.23.1.28

Abstract

PURPOSE
The purpose of this study was to report outcomes of ultrasound-guided percutaneous needle fasciotomy (USPNF) after intralesional steroid injections (SI).
METHODS
Tirty-two fingers (fourteen patients) treated by USPNF 4 weeks after intralesional SI from September, 2014 to October, 2016 were reviewed. At 6 months follow-up, outcome measurements were self-reported satisfaction, clinical improvement, clinical success, recurrence and complications.
RESULTS
All fingers showed clinical improvement with 100% satisfaction. Clinical success rates of ring and little fingers were 64.29% and 44.44%, respectively (p=0.18). Clinical improvement were greater in the metacarpophalangeal joint (MCPJ) than the proximal interphalangeal joint (PIPJ), but the difference was not significant (100.00% vs. 84.62%, p=0.07). Superior clinical success was noted in the MCPJ compared to the PIPJ (79.31% vs. 23.08%, p < 0.001). The mean percentages of improvement in the contracture angle were 92.48% for MCPJ and 65.58% for PIPJ. No complication was noted.
CONCLUSION
Intralesional SI followed by USPNF for the treatment of Dupuytren's contracture showed satisfactory outcomes, USPNF technique can be an alternative to the open technique.

Keyword

Dupuytren contracture; Fasciotomy; Injections

MeSH Terms

Contracture
Dupuytren Contracture*
Fingers
Follow-Up Studies
Joints
Metacarpophalangeal Joint
Needles*
Recurrence

Figure

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  Fig. 1 Intralesional injection of triamcinolone acetonide into a palmar nodule of Dupuytren's disease. The triamcinolone injection is preceded by an injection of lidocaine distal to the nodule under ultrasonography guide.

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  Fig. 2 (A) Utrasono-guided percutaneous needle fasciotomy is performed with 18 gage needle under sterile draping. (B) Ultrasonography image of percutaneous needle fasciotomy (arrow).

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  Fig. 3 Photograph of 64-year-old male with Dupuytren's contracture of both little finger (A) preoperatively both little finger showed flexion contracture. (B) At the 6 months later procedure, clinical improvement was obtained.

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  Fig. 4 Photograph of 59-year-old male with Dupuytren's contracture of multiple fingers (A) preoperatively both hand showed flexion contracture. (B) At the 6 months later procedure, clinical success was obtained.

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