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8/6/2019 Dupuytren Disease. Jlio Andr, Fernando Cruz, M Jos Maio
1/23
8/6/2019 Dupuytren Disease. Jlio Andr, Fernando Cruz, M Jos Maio
2/23
Dupuytren Disease
Pedro Simas
Leonor Fernandes
Teresa Marques
Jlio Andr Almeida
Hospital Garcia de Orta - Almada
Director - Dr. Craveiro Lopes
8/6/2019 Dupuytren Disease. Jlio Andr, Fernando Cruz, M Jos Maio
3/23
Introduction
1st described Guillaume Dupuytren (1831)
Palmar Fibromatosis
Incidence male related
Prevalence northern Europe
Risk factors diabetes, alcohol, tobacco
PIP contracture 4th and 5th fingers
8/6/2019 Dupuytren Disease. Jlio Andr, Fernando Cruz, M Jos Maio
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PIP Contracture
Amputation ofmedial and distal phalanx
Ressection ofmedial phalange Arthrodesis
Open
Fixation with Kirschner wire
Joint replacement???
Persistent deformity after distal selective fascectomy
8/6/2019 Dupuytren Disease. Jlio Andr, Fernando Cruz, M Jos Maio
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PIP Contracture
Phalanx or finger mostly 5th finger
Severe functional deficit or vascular injury
Recurrent disease
Amputation of the medial and distal phalange
8/6/2019 Dupuytren Disease. Jlio Andr, Fernando Cruz, M Jos Maio
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8/6/2019 Dupuytren Disease. Jlio Andr, Fernando Cruz, M Jos Maio
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PIP Contracture
Open or fixation with K-wire
Good functional outcome
DIP extension Pseudoboutonnire
Arthrodesis
8/6/2019 Dupuytren Disease. Jlio Andr, Fernando Cruz, M Jos Maio
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Material and Methods
2000-2006
119 patients operated
102 patients evaluated 120 hands 196 rays
7 PIP arthrodesis
16 complications
4 reoperated
8/6/2019 Dupuytren Disease. Jlio Andr, Fernando Cruz, M Jos Maio
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Objectives
Evaluate the influence of comorbidities
diabetes
Evaluate the influence of tobacco and alcohol in
the prevalence and evolution of the disease
Evaluate the quality of treatment
8/6/2019 Dupuytren Disease. Jlio Andr, Fernando Cruz, M Jos Maio
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Results
Gender
M:F = 6:1
Age of beginning of the disease
Average interval between beginning the disease and surgery 10,78 years
8/6/2019 Dupuytren Disease. Jlio Andr, Fernando Cruz, M Jos Maio
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Results
Operated rays
Bilateral cases 17 patients
8/6/2019 Dupuytren Disease. Jlio Andr, Fernando Cruz, M Jos Maio
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8/6/2019 Dupuytren Disease. Jlio Andr, Fernando Cruz, M Jos Maio
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Results
Tobacco Alcohol
Positive family history 18%
8/6/2019 Dupuytren Disease. Jlio Andr, Fernando Cruz, M Jos Maio
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Results Comorbidities Hand pathology
8/6/2019 Dupuytren Disease. Jlio Andr, Fernando Cruz, M Jos Maio
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8/6/2019 Dupuytren Disease. Jlio Andr, Fernando Cruz, M Jos Maio
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Results
Complications
Sudecks athrophy 3
Dysesthesia 9
Infection 3
Hypertrophic scars 1
Skin cicatrization problems 15
8/6/2019 Dupuytren Disease. Jlio Andr, Fernando Cruz, M Jos Maio
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Results
Patients satisfaction
Exc
elle
nt
Goo
dP
oor
Fair
8/6/2019 Dupuytren Disease. Jlio Andr, Fernando Cruz, M Jos Maio
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Analysis of Results
Diabetes
Complications
- Diabetes: 46% and No-diabetes: 18%
Recurrences
- Diabetes: 30% and No-diabetes: 17%
Tubiana Classification Post-operative
Diabetes 1,14 (0-3)No-diabetes 0,67 (0-3)
p
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Analysis of Results
AlcoholPost-operative
Alcohol 0,91 (0-3)No-alcohol 0,59 (0-3)
Tubiana Classification
Complications
- Alcohol: 24% and No-alcohol: 33%
Recurrences
- Alcohol: 19% and No-alcohol: 21%
p>0,01
p>0,01
8/6/2019 Dupuytren Disease. Jlio Andr, Fernando Cruz, M Jos Maio
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Tubiana Classification Post-operative
Smoking 0,83 (0-3)Non-smoking 0,88 (0-3)
Analysis of Results
Tobacco
Complications
- Smoking: 28% and Non-smoking: 26%
Recurrences
- Smoking: 18% and Non-smoking: 22%
p>0,01
p>0,01
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PIP arthrodesis
Persistent deformity uncorrected by distal fascectomy
Arthrodesis fixation with Kirschner wires
6 patients/ 7 raysGender Diabetes Tobacco Ray Recurrency Satisfaction
M Yes Yes R5 Yes Good
F Yes No R5 Yes Good
M No No R4,R5 No Fair
M No Yes R5 No Fair
M No Yes R5 No Bad
M No No R5 No Deceased
Analysis of Results
PIP
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Conclusions
Excellent and good results: 74%
Diabetes related to disease recurrence and complications
Tobacco and Alcohol not related? ( other studies)
PIP arthrodesis small n of patients
PIP arthrodesis better results in recurrent disease?
8/6/2019 Dupuytren Disease. Jlio Andr, Fernando Cruz, M Jos Maio
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OBRIGADO!