Annals of Internal MedicineSurgery, Needle Fasciotomy, or Collagenase Injection for Dupuytren Contracture

Comparative Effectiveness of Dupuytren Contracture Treatments: A Multicenter Trial Analysis

In a comprehensive multicenter trial, researchers sought to evaluate the long-term effectiveness of three different treatments for Dupuytren contracture—a condition that affects the hand, causing one or more fingers to bend towards the palm. The study, conducted across six public hospitals in Finland, compared surgery, needle fasciotomy, and collagenase injections in patients who had not previously undergone treatment for the condition. This analysis provides critical insights for physicians on the relative success rates and outcomes of these treatment modalities over a two-year period.

Study Design:

• Type of Study: Multicenter, randomized, outcome assessor–blinded, superiority trial registered at ClinicalTrials.gov (NCT03192020).
• Setting: Six public hospitals in Finland.
• Participants: 302 individuals with treatment-naive Dupuytren contracture (contracture angle <135°).
• Interventions: Participants were randomly assigned to undergo surgery (n=101), needle fasciotomy (n=101), or collagenase injections (n=100).

Key Findings:

• Initial Success Rates (3 months): Comparable across all treatments—71% for surgery, 73% for needle fasciotomy, and 73% for collagenase.
• Long-term Success Rates (2 years): Surgery demonstrated superior success rates compared to needle fasciotomy (78% vs. 50%) and collagenase (78% vs. 65%).
• Secondary Outcomes: Included hand function, pain, quality of life, patient satisfaction, residual contracture angle, finger flexion, risk for retreatment, and serious adverse events, which paralleled the primary success rate findings.
• Limitation: Lack of participant blinding.

HCN Medical Memo
Although initial treatment outcomes for Dupuytren contracture were comparable, surgery maintained higher success rates at the two-year mark compared to both needle fasciotomy and collagenase, even after accounting for retreatments.

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