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

Jae-Sung Yoo; Kang Heo; Seong-Jun Kim; Kwang-Hee Park; Jong-Pil Kim

doi:10.12790/ahm.2018.23.1.28

Journal List > Arch Hand Microsurg > v.23(1) > 1106628

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Yoo, Heo, Kim, Park, and Kim: Ultrasound-Guided Percutaneous Needle Fasciotomy after Steroid Injection for Dupuytren's Contracture

Hand

Archives of Hand and Microsurgery 2018; 23(1): 28-34.

Published online: 2 March 2018

DOI: https://doi.org/10.12790/ahm.2018.23.1.28

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

Jae-Sung Yoo¹, Kang Heo¹, Seong-Jun Kim¹, Kwang-Hee Park¹, Jong-Pil Kim^1,²

¹Department of Orthopaedic Surgery, Dankook University College of Medicine, Cheonan, Korea.

²Department of Kinesiology and Medical Science, Graduate School, Dankook University, Cheonan, Korea.

Corresponding author: Jong-Pil Kim. Department of Orthopaedic Surgery, Dankook University College of Medicine, 119 Dandae-ro, Dongnam-gu, Cheonan 31116, Korea. TEL: +82-41-550-6579, FAX: +82-41-556-3238, kimjp@dankook.ac.kr

Received 23 October 2017 Revised 12 December 2017 Accepted 19 December 2017

Korean Society for Surgery of the Hand, Korean Society for Microsurgery, and Korean Society for Surgery of the Peripheral Nerve

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Dupuytren contracture, Fasciotomy, Injections

Figures and Tables

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.

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).

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.

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.

Table 1

Demographic data

Values are presented as mean±standard deviation or number (%).

Table 2

Clinical outcomes according to the finger

Values are presented as number (%).

Table 3

Clinical outcomes according to the affected joints

Values are presented as number (%).

Table 4

Comparison with McMillan's results

Notes

^{CONFLICTS OF INTEREST} The authors have nothing to disclose.

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