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md:dupuytrens

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md:dupuytrens [2019/04/09 12:20]
218.186.142.130 created 		md:dupuytrens [2020/03/24 23:57] (current)
admin added reference to leafblad2019
Line 68: Line 68:
  
 Initially presents with nodule in the palmar fascia Initially presents with nodule in the palmar fascia
- • Nodule with or without palmar fibrosis +  * Nodule with or without palmar fibrosis 
- • Cord +  * Cord 
- • Associations +  * Associations 
- ? Ledderhose disease (plantar) 5-20% +    * Ledderhose disease (plantar) 5-20% 
- ? Peyronies diesease (penile) 2-4% +    * Peyronies diesease (penile) 2-4% 
- ? Garrod's pads (PIPJ dorsum) 1-44%+    * Garrod's pads (PIPJ dorsum) 1-44%
  
 Clinical types Clinical types
- • Typical - bilateral in 50%, if unilateral mor likely on Rt; ulnar side: RF>SF>MF +  * Typical - bilateral in 50%, if unilateral mor likely on Rt; ulnar side: RF>SF>MF 
- • Atypical - +  * Atypical - 
- ? race, gender irrelevant, FH absent +    * race, gender irrelevant, FH absent 
- ? h/o RA/DM +    * h/o RA/DM 
- ? develops after hand surgery or trauma +    * develops after hand surgery or trauma 
- ? single sided+    * single sided
  
 Dupuytren's diathesis Dupuytren's diathesis
Line 119: Line 119:
  6 Arthroplasty  6 Arthroplasty
  7 Amputation - only if all else has failed; mainly for reasons of hygiene  7 Amputation - only if all else has failed; mainly for reasons of hygiene
 +
 +== Choosing a surgical option ==
 +
 +  * I am most familiar with partial fasciectomy. It works well, and lasts. [[jnl:leafblad2019]] reported a single surgeon experience of needle aponeurotomy vs collagenase vs open fasciectomy. At 5 years, reintervention rate for OF was 4% vs (55-60% for NA and Co). Cumulative costs was lower than Co, but higher than NA.
 +
 +
  
 Complications of surgery Complications of surgery
Line 129: Line 135:
  
 Historical Notes Historical Notes
- • 1614 - Felix Platter (Swiss physician) - Stonemason's Hand - flexor tendon contracture +  * 1614 - Felix Platter (Swiss physician) - Stonemason's Hand - flexor tendon contracture 
- • 1787 - Cline - Palmar fasciotomy +  * 1787 - Cline - Palmar fasciotomy 
- • 1831 - Guillaime Dupuytren's lecture at Hote Dieu (Parisian Surgeon) - detailed normal and abnormal anatomy of plantar fascia; subsequently published work+  * 1831 - Guillaime Dupuytren's lecture at Hote Dieu (Parisian Surgeon) - detailed normal and abnormal anatomy of plantar fascia; subsequently published work
  
 References References
- 1 Hand Secrets +  - Hand Secrets 
- 2 Mc Cash +  - Mc Cash 
- 3 HSU2+  - HSU2
md/dupuytrens.1554812455.txt.gz · Last modified: 2020/03/24 02:34 (external edit)

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