The Surgical Treatment of Dupuytren’s Contracture: A Synthesis of Techniques Surgical management of Dupuytren's contracture in Europe: regional analysis of a surgeon survey and patient chart review. Dupuytren's Contracture. The Safety and Efficacy of Collagenase Treatment. Hand function and quality of life before and after fasciectomy for Dupuytren contracture. Injectable Collagenase Versus Percutaneous Needle Fasciotomy for Dupuytren Contracture in Proximal Interphalangeal Joints: A Randomized Controlled Trial. Skin Tension in the Aetiology of Dupuytren’s Disease; a Prospective Trial Treatment of Recurrent Dupuytren Contracture in Joints Previously Effectively Treated With Collagenase Clostridium histolyticum. Percutaneous Aponeurotomy and Lipofilling (PALF) versus Limited Fasciectomy in Patients with Primary Dupuytren’s Contracture: A Prospective, Randomized, Controlled Trial New insights into the immediate outcome of collagenase injections for Dupuytren’s contracture The use of a passive motion machine in the postoperative rehabilitation of Dupuytren's disease. Comparison of Treatment Outcome After Collagenase and Needle Fasciotomy for Dupuytren Contracture: A Randomized, Single-Blinded, Clinical Trial With a 1-Year Follow-Up. Night-time splinting after fasciectomy or dermo-fasciectomy for Dupuytren's contracture: a pragmatic, multi-centre, randomised controlled trial Severe contractures of the proximal interphalangeal joint in Dupuytren's disease: results of a prospective trial of operative correction and dynamic extension splinting. Recurrence after Surgery for Dupuytren’s Disease: A Randomized Trial of Two Skin Incisions Surgical treatment of Dupuytren’s disease – outcome and health economy in relation to smoking and diabetes The effect of night extension orthoses following surgical release of Dupuytren contracture: a single-center, randomized, controlled trial. Efficacy and safety of collagenase Clostridium histolyticum injection for Dupuytren contracture: report of 40 cases
Dupuytren ’s disease is an affliction of the palmar fascia . Selective fasciectomy is recommended once contracture has occurred . Alternatives for wound closure include tissue rearrangement , the open palm technique , and full-thickness skin grafting . In this prospect i ve study , a new “ synthesis ” technique was used to treat a cohort of patients with advanced Dupuytren ’s disease . The results were then compared with those of a second cohort of patients who underwent the open palm technique . Thirty consecutive patients were selected . Ten patients ( nine men and one woman ; average age , 67 years ) underwent the open palm technique , and 20 patients ( 18 men and two women ; average age , 70 years ) underwent the synthesis method .  Follow-up was 3.5 years for the open palm group and 2.7 years for the synthesis group . All patients in both groups improved with respect to motion , function , appearance , and satisfaction . Objective ly , for the open palm technique , metacarpophalangeal joint contracture decreased from 50 degrees to 0 degrees , and proximal interphalangeal joint contracture decreased from 40 degrees to 6 degrees . Using the synthesis method , metacarpophalangeal joint contracture decreased from 57 degrees to 0 degrees , and proximal interphalangeal joint contracture decreased from 58 degrees to 10 degrees . The Disabilities of the Arm , Shoulder , and H and Test scores decreased from 37 to 30 in both groups . There were no significant differences between groups in these parameters . The two significant intergroup differences were healing time ( 40 days for the open palm technique versus 28 days for the synthesis method ) and recurrence rate ( 50 percent for open palm versus 0 percent for synthesis ) . The synthesis technique combines with success the best features of current methods for the surgical treatment of advanced Dupuytren ’s disease AIM We explored regional variations in the surgical management of patients with Dupuytren 's contracture ( DC ) in 12 European countries using a surgeon survey and patient chart review . METHODS Twelve countries participated : Denmark , Finl and , Sweden ( Nordic region ) ; Czech Republic , Hungary , Pol and ( East ) ; France , Germany , the Netherl and s , UK ( West ) ; Italy , Spain ( Mediterranean ) . For the survey , a r and om sample of orthopaedic/plastic surgeons ( n = 687 ) with 3 - 30 years ' experience was asked about DC procedures performed during the previous 12 months . For the chart review ( n = 3357 ) , information from up to five consecutive patients was extracted . Descriptive statistics are reported . RESULTS Ninety-five per cent of all surgeons used fasciectomy for DC , followed by fasciotomy ( 70 % ) , dermofasciectomy ( 38 % ) and percutaneous needle fasciotomy ( 35 % ) . Most surgeons were satisfied with fasciectomy over other procedures . Recommended time away from work and duration of physical therapy  increased with the invasiveness of the procedure . The intra-operative complication rate was 4.0 % ; the postoperative complication rate was 34 % . Overall , ≥ 97 % of the procedures were rated by surgeons as having a positive outcome . Across all regions , 54 % of patients had no nodules or contracture after the procedures . Only 2 % of patients required retreatment within the first year of surgery . Important inter- and intraregional differences in these aspects of patient management are described . CONCLUSIONS Underst and ing current regional treatment patterns and their relationships to country-specific health systems may facilitate earlier identification of , and intervention for , DD and help to optimise the overall treatment for patients with this chronic condition BACKGROUND Our main goal was to see if treatment with collagenase injection is safe and effective and to assess patient satisfaction with this new treatment . METHODS We prospect ively followed 77 consecutive patients , treated for contracture in 91 fingers and 142 joints that received total of 109 collagenase injections .  The patients were review ed on the first and second day and at 4 and 12 months . A contracture reduced to five degrees or less at 12 months after the last injection , was considered to be a successful outcome . RESULTS A mean of 1.2 injections were used per patient and 0.8 injections per joint . There was a significant improvement in mean passive extension deficit . Out of the 142 joints treated , 84 ( 59 % ) met our criterion for a successful outcome ; 56 ( 80 % ) out of 70 MCP joints and 28 ( 39 % ) out of 72 PIP joints . There were also significant improvements in both h and function and pain . No serious adverse events were observed . The mean patient satisfaction with the treatment at the 12-month follow up was a VAS score of 78 ( 0 = none ; 100 = complete ) and only 11 % stated that they would not have consented to the treatment if they had known the outcome in advance . CONCLUSIONS Treatment of Dupuytren 's disease with collagenase injection is both safe and effective . It is now our primary treatment for Dupuytren 's disease PURPOSE To describe changes in joint motion , sensibility , and scar pliability and to investigate the patients ' expectations , self-reported recovery , and satisfaction with h and function , disability , and quality of life after surgery and h and therapy for Dupuytren disease . METHODS This prospect i ve cohort study collected measurements before surgery and 3 , 6 , and 12 months after surgery and h and therapy .  Ninety patients with total active extension deficits of 60 ° or more from Dupuytren contracture were included . Outcomes measures were range of motion ; sensibility ; scar pliability ; self-reported outcomes on expectations , recovery , and satisfaction with h and function ; Disabilities of the Arm , Shoulder , and H and scores ; safety and social issues of h and function ; physical activity habits ; and quality of life with the Euroqol . RESULTS The extension deficit decreased , and there was a transient decrease in active finger flexion during the first year after surgery . Sensibility remained unaffected . Generally , patients with surgery on multiple fingers had worse scar pliability . The majority of the patients had their expectations met , and at 6 months , 32 % considered h and function as fully recovered , and 73 % were satisfied with their h and function . Fear of hurting the h and and worry about not trusting the h and function were of greatest concern among safety and social issues . The Disability of the Arm , Shoulder , and H and score and the Euroqol improved over time . CONCLUSIONS After surgery and h and therapy , disability decreased independent of single or multiple operated fingers . The total active finger extension improved enough for the patients to reach a functional range of motion despite an impairment of active finger flexion still present 12 months after treatment . TYPE OF STUDY /LEVEL OF EVIDENCE Therapeutic IV PURPOSE Collagenase Clostridium histolyticum ( CCH ) injection was introduced commercially as a treatment for Dupuytren contracture following initial phase-3 investigations in 2009 with promising results . However , the efficacy of CCH has not been prospect ively investigated in a direct comparison to other active treatments of Dupuytren contracture with more than 1-year follow-up , despite a wide and increasing clinical use . METHOD In this prospect i ve , independent , open-label , r and omized controlled trial , ( Clinical trials.gov ; NCT 01538017 ) , percutaneous needle fasciotomy ( PNF ) was directly compared with CCH .  Fifty patients with primary isolated proximal interphalangeal joint Dupuytren contractures were enrolled and followed for 2 years . The primary outcome was clinical improvement defined as a reduction in contracture by 50 % or more relative to baseline . Secondary outcomes included change in contracture , recurrence , adverse events , complications , and Disabilities of the Arm , Shoulder , and H and question naire score . RESULTS Clinical improvement at 2 years was maintained in 7 % of CCH patients ( 2 of 29 ) and 29 % of PNF patients ( 6 of 21 ) . Collagenase Clostridium histolyticum led to more , mainly transient , complications , in 93 % of patients versus 24 % of the patients treated with PNF . No other differences were observed . CONCLUSIONS This study provides evidence that CCH is not superior to PNF in the treatment of isolated proximal interphalangeal joint Dupuytren contracture regarding clinical outcome , and it led to more complications than PNF . TYPE OF STUDY /LEVEL OF EVIDENCE Therapeutic Tension in the palmar fascia has been proposed as a factor causing Dupuytren ’s disease . If tension does stimulate the growth of new Dupuytren ’s tissue , relieving longitudinal tension should reduce the recurrence rate following surgery . Thirty patients with palmar Dupuytren ’s contracture of a single ray that affected only the metacarpophalangeal joint were divided into two groups . Both groups had a fasciotomy : one group through a transverse incision that was closed directly and the other through a longitudinal incision with Z-plasty closure . Half the patients ( seven of 14 ) who had direct closure had recurrence at 2 years as compared to two of the 13 in the Z-plasty group . The trial was stopped at the interim analysis stage due to the high recurrence rate in the first group . These results are consistent with the tension hypothesis for the aetiology of Dupuytren ’s disease PURPOSE Collagenase Clostridium histolyticum ( CCH ) is approved for the treatment of adults with Dupuytren contracture with a palpable cord . This open-label , phase 4 study evaluated the safety and efficacy of CCH for the retreatment of recurrent contractures in joints that were previously effectively treated with CCH . METHODS Patients participating in a long-term follow-up study who had contracture recurrence ( increased ≥ 20 ° with a palpable cord ) after successful treatment in the previous study were eligible . Recurrent joint contractures were treated with up to 3 CCH injections ( ∼ 1 month apart ) . Patients were followed for 1 year to evaluate safety . Assessment s included change in joint contracture , range of motion , and the percentage of joints that achieved contracture of 5 ° or less at day 30 after the last injection . RESULTS The efficacy analysis included 51 patients with 1 treated joint per patient ( 31 metacarpophalangeal , 20 proximal interphalangeal ) . A total of 35 joints ( 69 % ) received 1 injection , 12 ( 24 % ) received 2 injections , and 4 ( 8 % ) received 3 injections . Fifty-seven percent of joints achieved contracture of 5 ° or less ( 29 of 51 ) . Overall , 86 % ( 43 of 50 ) patients had a 20 ° or greater increase in range of motion . The adverse event profile was consistent with previous studies . One ligament injury was reported . CONCLUSIONS At a short-term follow-up of 1 year , recurrent contracture in joints previously successfully treated with CCH may be effectively retreated with up to 3 injections of CCH . TYPE OF STUDY /LEVEL OF EVIDENCE Therapeutic IV Background : As an alternative to needle aponeurotomy release and limited fasciectomy treatment of Dupuytren ’s contracture , the authors introduced an extensive percutaneous aponeurotomy and lipofilling ( PALF ) procedure . In their previous study , the authors reported that contractures significantly improved and most patients returned to normal use of the h and within 2 to 4 weeks . To establish the safety and efficacy of PALF , the authors compared it to the st and ard limited fasciectomy in a single-blind , multicenter , prospect i ve , r and omized , controlled trial . Methods : Patients with a primary Dupuytren ’s contracture were assigned r and omly to the limited fasciectomy group or the PALF group . Patients were measured at baseline and at 2 weeks , 3 weeks , 6 months , and 1 year postoperatively . Primary outcome of the trial was contracture correction and convalescence time . Groups were compared using a mixed models approach . Results : Eighty patients were r and omized to PALF or limited fasciectomy . In both groups , almost full metacarpophalangeal joint contracture correction was obtained , whereas for the proximal interphalangeal joint , some residual contracture remained . Patients in the PALF group returned significantly earlier to their normal daily activity . At 1 year after surgery , no significant differences in recurrence rate or h and function were present . However , limited fasciectomy seems to have a higher incidence of permanent complications . Conclusions : PALF demonstrates a significantly shorter convalescence , similar operative contracture correction , lower incidence of long-term complications , and no significant difference regarding 1-year postoperative results compared with limited fasciectomy . It is therefore a valuable , minimally invasive alternative to limited fasciectomy in the treatment of Dupuytren ’s disease . CLINICAL QUESTION /LEVEL OF EVIDENCE : Therapeutic , II Collagenase clostridium histolyticum is now established as an effective and safe option to treat patients with a single joint affected with Dupuytren ’s contracture . We have extended its use to  natatory and combined cords .  In a prospect i ve consecutive series of 298 cords in 237 patients , the mean total extension loss improved in cords crossing the metacarpophalangeal joint from 46 ° to 1 ° , in cords crossing the proximal interphalangeal joint from 56 ° to 7 ° , in natatory cords from 130 ° to 25 ° and in combined cords from 102 ° to 16 ° . The immediate correction of combined cords and natatory cords was less reliable than that obtained in cords crossing the metacarpophalangeal joint or proximal interphalangeal joint . Less severe pre-intervention contractures tended to correct better . We found a high complication rate , which may cause alarm . A total of 21 % developed skin splits , with the risk of skin splits generally increasing with more severe pre-injection deformity . Blood blisters were only encountered after manipulation of the more severe contractures . A total of 23 patients ( 8 % ) had a spontaneous rupture and 57 patients ( 19 % ) had a partial spontaneous rupture . Only 4.9 % needed a second injection . We noticed a learning curve , with seven of the first 20 cords ( 35 % ) needing a second injection to achieve a satisfactory correction and then only seven ( 2.5 % ) in the rest . Level of evidence : The purpose of this study was to prospect ively compare the postoperative use of passive motion ( PM ) and st and ard h and therapy after surgical treatment of Dupuytren 's disease for extent and rate of recovery of joint motion . Our data indicate that metacarpophalangeal joint contractures improved completely to a mean of 0 degrees , regardless of the postoperative protocol . Contractures at the proximal interphalangeal joint showed incomplete recovery in both study groups , with a mean residual contracture of 28 degrees for PM patients and 38 degrees for control patients . Contractures of the metacarpophalangeal-proximal interphalangeal joints in the same finger showed complete metacarpophalangeal joint recovery to a mean of 0 degrees but incomplete proximal interphalangeal joint recovery with a mean residual contracture of 30 degrees in PM patients and 22 degrees in control patients . We conclude that the use of a PM machine in the rehabilitation of Dupuytren 's disease does not offer an advantage in the postoperative management of this condition PURPOSE This study compared the efficacy of collagenase treatment and needle fasciotomy for contracture of the metacarpophalangeal ( MCP ) joint in Dupuytren disease . METHODS This is a prospect i ve , single-blinded , r and omized study with follow-up 1 week and 1 year after treatment . One hundred and forty patients with an MCP contracture of 20 ° or more in a single finger were enrolled , of whom 69 patients were r and omized to collagenase treatment and 71 patients to needle fasciotomy .  The patients were followed at 1 week and were examined by a physiotherapist after 1 year . Measurements of joint movement and grip strength were recorded as well as patient-perceived outcomes measured by the Unité Rhumatologique des Affections de la Main ( URAM ) question naire and a visual analog scale ( VAS ) for the estimation of procedural pain and subjective treatment efficacy . RESULTS Eighty-eight percent of the patients in the collagenase group and 90 % of the patients in the needle fasciotomy group had a reduction in their MCP contracture to less than 5 ° 1 week after treatment , and the median gains in passive MCP movement were 48 ° and 46 ° , respectively . The median VAS score for procedural pain was 4.9 of 10 in the collagenase group and 2.7 of 10 in the needle fasciotomy group . After 1 year , 90 % of the patients in both groups had full extension of the treated MCP joint . One patient in each group had a recurrence of the contracture . The median improvement in URAM score was 8 units in both groups and the VAS estimation of treatment efficacy by the patients was 8.7 of 10 in both groups . CONCLUSIONS There was no significant difference between the treatment outcomes after collagenase and needle fasciotomy treatment after 1 year . TYPE OF STUDY /LEVEL OF EVIDENCE Therapeutic Background Dupuytren 's disease is a progressive fibroproliferative disorder which can result in fixed flexion contractures of digits and impaired h and function . St and ard treatment involves surgical release or excision followed by post-operative h and therapy and splinting , however the evidence supporting night splinting is of low quality and equivocal . Methods A multi-centre , pragmatic , open , r and omised controlled trial was conducted to evaluate the effect of night splinting on self-reported function , finger extension and satisfaction in patients undergoing fasciectomy or dermofasciectomy . 154 patients from 5 regional hospitals were r and omised after surgery to receive h and therapy only ( n = 77 ) or h and therapy with night-splinting ( n = 77 ) . Primary outcome was self-reported function using the Disabilities of the Arm , Shoulder and H and ( DASH ) question naire . Secondary outcomes were finger range of motion and patient satisfaction . Primary analysis was by intention to treat . Results 148 ( 96 % ) patients completed follow-up at 12 months . No statistically significant differences were observed on the DASH question naire ( 0 - 100 scale : adjusted mean diff . 0.66 , 95%CI - 2.79 to 4.11 , p = 0.703 ) , total extension deficit of operated digits ( degrees : adjusted mean diff 5.11 , 95%CI -2.33 to 12.55 , p = 0.172 ) or patient satisfaction ( 0 - 10 numerical rating scale : adjusted mean diff -0.35 , 95%CI -1.04 to 0.34 , p = 0.315 ) at 1 year post surgery . Similarly , in a secondary per protocol analysis no statistically significant differences were observed between the groups in any of the outcomes . Conclusions No differences were observed in self-reported upper limb disability or active range of motion between a group of patients who were all routinely splinted after surgery and a group of patients receiving h and therapy and only splinted if and when contractures occurred . Given the added expense of therapists ' time , thermoplastic material s and the potential inconvenience to patients having to wear a device , the routine addition of night-time splinting for all patients after fasciectomy or dermofasciectomy is not recommended except where extension deficits reoccur . Trial registration The trial was registered as an International St and ard R and omised Controlled Trial IS RCT In a prospect i ve study , 23 proximal interphalangeal joints that were severely contracted ( > or = 45 degrees ) as a result of Dupuytren 's disease underwent operative correction and 6 months of dynamic extension splinting . Proximal interphalangeal joint extension was measured preoperatively and postoperatively at 3-month intervals for 1 year and at 6-month intervals thereafter . Mean follow-up was 2 years ( minimum , 1 year ) . Overall , at 2 years , 44 % improvement in proximal interphalangeal joint extension was noted . Mean improvement of 59 % in proximal interphalangeal joint extension was noted in patients who complied with the postoperative dynamic extension splinting program . Patients who were noncomplaint demonstrated a 25 % improvement in proximal interphalangeal joint extension . The difference in values between patients who were compliant and those who were not was statistically significant . Other factors -- severity of contracture , digit involved , and the necessity for capsular release -- were not significantly related to outcome . This study suggests that soft tissue responds to continuous dynamic extension stresses and can be remodeled over time We studied the influence of the type of skin incision on the recurrence rate  following fasciectomy for Dupuytren ’s disease . Patients were r and omized to a longitudinal incision closed with Z-plasties or a modified Bruner incision closed by Y – V plasties .  Follow-up was for at least 2 years or until a recurrence was noted . We found no statistical difference in recurrence rate between patients having these two skin incisions and closures Background The conventional treatment for Dupuytren ’s disease is surgery . The introduction of alternative treatment strategies creates a need to track outcomes and costs relating to surgical treatment and risk factors , such as smoking and diabetes . This was the aim of the present study . Methods In a prospect i ve study , the outcome of open surgical treatment for finger flexion contracture in Dupuytren ’s disease ( 175 patients ; 182 surgical procedures ) was studied by evaluating valid QuickDASH forms answered by subjects before surgery and one year postoperatively . Data were also obtained from medical records , and preoperative declarations concerning health . Results In all subjects ( median [ 25 % - 75 % percentiles ] age 68 [ 62 - 73 ] ) , the QuickDASH score improved from 22 [ 9 - 36 ] to 5 [ 0 - 18 ] . Smokers ( 27/179 procedures ) were younger and had a more severe degree of disease and dysfunction preoperatively than non-smokers , but the outcome of surgery did not differ between the groups . Subjects with diabetes ( 20/181 procedures ) were younger than those without diabetes , but their disease severity or outcome did not differ . H and specialists operated faster than residents , but the surgical outcome did not differ . Healthcare costs for surgery for Dupuytren ’s contracture were $ 2392 ( € 1859 ) , which were not higher among smokers or subjects with diabetes . Only 22 patients remained in hospital ( 2 [ 1 - 2.3 ] days ) and 28 patients needed sick leave ( 28 [ 21 - 31 ] days ) . The occurrence of necrosis of skin flaps ( 12 % ) or infections ( 6 % ) was no more frequent among smokers or those with diabetes . Conclusions There is no difference in surgical outcome for finger flexion contracture in Dupuytren ’s disease between smokers and non-smokers or between subjects with or without diabetes , although smokers had more severe preoperative contracture . The costs for surgical treatment for finger flexion contracture in Dupuytren ’s disease should be viewed in relation to that for other treatment strategies PURPOSE To clarify the efficacy and detrimental effects of orthoses used to maintain finger extension following surgical release of Dupuytren contracture . METHODS We conducted a single-center , r and omized , controlled trial to investigate the effect of night extension orthoses on finger range of motion and h and function for 3 months following surgical release of Dupuytren contracture . We also wanted to determine how well finger extension was maintained in the total sample . We r and omized 56 patients to receive a night extension orthosis plus h and therapy  ( n = 26 ) or h and therapy alone ( n = 30 ) . The primary outcome was total active extension of the operated fingers ( ° ) . Secondary outcomes were total active flexion of the operated fingers ( ° ) , active distal palmar crease ( cm ) , grip strength ( kg ) , and self-reported h and function using the Disabilities of the Arm , Shoulder , and H and question naire ( 0 - 100 scale ) . RESULTS There were no statistically significant differences between the no-orthosis and orthosis groups for total active extension or for any of the secondary outcomes . Between the first postoperative measure and 3 months after surgery , 62 % of little fingers had maintained or improved total active extension . CONCLUSIONS The use of a night extension orthosis in combination with st and ard h and therapy has no greater effect on maintaining finger extension than h and therapy alone in the 3 months following surgical release of Dupuytren contracture . Our results indicate that the practice of providing every patient with a night extension orthosis following surgical release of Dupuytren contracture may not be justified except for cases in which extension loss occurs after surgery . Our results also challenge clinicians to research ways of maintaining finger extension in a greater number of patients Abstract Background Dupuytren ’s disease ( DD ) is a fibroproliferative pathology that affects the palmar aponeurosis causing the development of nodules and collagen cords and the progressive flexion of the fingers . The st and ard procedure is surgical fasciectomy , followed by high recurrence rates . Collagenase Clostridium histolyticum ( CCH ) injection represents an innovative noninvasive approach to the treatment of DD . This prospect i ve study was design ed to examine the efficacy and safety of CCH injection performed in the outpatient , using local anesthesia . Material s and methods Forty patients [ 32 metacarpophalangeal ( MP ) , 8 proximal interphalangeal ( PIP ) ] with Dupuytren ’s contracture of at least 20 ° for MP joint and any degree for PIP joint were included . The mean age was 66 . All joints were treated with a single vial of collagenase injection and manual breaking of the cord 24 h after . All adverse effects ( AEs ) were monitored . Patients were checked 7 , 30 , 90 , and 180 days after the injection . Primary endpoint was a reduction in digit contracture within 0 ° –5 ° of normal extension . Secondary endpoints were the improvement of range of motion , the evaluation of AEs incidence , and cost-effectiveness of collagenase treatment . Results About 67.5 % of patients obtained a clinical success . At 6 months , a further 7.5 % attained the same result . The mean contracture of treated joints was 5.3º for MP and 6.8 ° for PIP joints . Twenty-three patients had one or more mild-to-moderate side effects . Conclusions The use of collagenase appears to be an effective and safe method for the treatment of Dupuytren ’s contracture . Therapeutic success was achieved in a significant percentage of patients . The incidence of side effects was higher , but they were local reactions of short duration . The use of a single collagenase vial in patients treated in day surgery appears more cost-effective than surgery
There are only three Level I studies comparing surgical techniques for the treatment of primary Dupuytren ’s contracture , and the evidence does not support one procedure above another , other than to show a particularly high recurrence rate after needle fasciotomy .
There is no consensus on the most effective operation for primary Dupuytren ’s contracture .
This systematic review evaluates the reported rates of recurrence and complications , as well as the strength of evidence , for individual procedures .