Prospective randomized controlled trial comparing 1-versus 7-day manipulation following collagenase injection for dupuytren contracture

Dayne T. Mickelson, Shelley S. Noland, Andrew J. Watt, Kathleen M. Kollitz, Nicholas B. Vedder, Jerry I. Huang

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Purpose To compare the efficacy, tolerance, and safety of manual manipulation at day 7 to day 1 following collagenase Clostridium histolyticum (CCH) injection for Dupuytren contracture. Methods Eligible patients were randomized to manipulation at day 1 versus day 7 following CCH injection. Preinjection, premanipulation, postmanipulation, and 30-day follow-up metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joint contractures were measured. Pain scores were recorded at each time point. Data were stratified per cohort based on primary joint treated (MCP vs PIP). Means were compared using paired and unpaired t-tests. Results Forty-three patients with 46 digits were eligible and were randomized to 1-day (22 digits) and 7-day (24 digits) manipulation. For MCP joints, there were no significant differences in flexion contractures between 1- and 7-day cohorts for initial (47° vs 46°), postmanipulation (0° vs 2°), or 30-day follow-up (1° vs 2°) measurements. Premanipulation, the residual contracture was significantly lower in the 7-day group (23° vs 40°). For PIP joints, there were no significant differences between 1- and 7-day cohorts for initial (63° vs 62°), premanipulation (56° vs 52°), postmanipulation (13° vs 15°), or 30-day (14° vs 16°) measurements. There were no significant differences in pain or skin tears between the 2 groups. No flexor tendon ruptures were observed. Conclusions The effectiveness of CCH in achieving correction of Dupuytren contractures was preserved when manipulation was performed on day 7, with no differences in correction, pain, or skin tears. These data suggest that manipulation can be scheduled at the convenience of the patient and surgeon within the first 7 days after injection.

Original languageEnglish (US)
Pages (from-to)1933-1941
Number of pages9
JournalJournal of Hand Surgery
Volume39
Issue number10
DOIs
StatePublished - Oct 1 2014
Externally publishedYes

Fingerprint

Microbial Collagenase
Dupuytren Contracture
Contracture
Collagenases
Metacarpophalangeal Joint
Randomized Controlled Trials
Pain
Injections
Joints
Skin
Tendons
Rupture
Safety

Keywords

  • Collagenase Clostridium histolyticum
  • Dupuytren contracture
  • follow-up
  • injection
  • timing

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Surgery
  • Medicine(all)

Cite this

Prospective randomized controlled trial comparing 1-versus 7-day manipulation following collagenase injection for dupuytren contracture. / Mickelson, Dayne T.; Noland, Shelley S.; Watt, Andrew J.; Kollitz, Kathleen M.; Vedder, Nicholas B.; Huang, Jerry I.

In: Journal of Hand Surgery, Vol. 39, No. 10, 01.10.2014, p. 1933-1941.

Research output: Contribution to journalArticle

Mickelson, Dayne T. ; Noland, Shelley S. ; Watt, Andrew J. ; Kollitz, Kathleen M. ; Vedder, Nicholas B. ; Huang, Jerry I. / Prospective randomized controlled trial comparing 1-versus 7-day manipulation following collagenase injection for dupuytren contracture. In: Journal of Hand Surgery. 2014 ; Vol. 39, No. 10. pp. 1933-1941.
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AU - Kollitz, Kathleen M.

AU - Vedder, Nicholas B.

AU - Huang, Jerry I.

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N2 - Purpose To compare the efficacy, tolerance, and safety of manual manipulation at day 7 to day 1 following collagenase Clostridium histolyticum (CCH) injection for Dupuytren contracture. Methods Eligible patients were randomized to manipulation at day 1 versus day 7 following CCH injection. Preinjection, premanipulation, postmanipulation, and 30-day follow-up metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joint contractures were measured. Pain scores were recorded at each time point. Data were stratified per cohort based on primary joint treated (MCP vs PIP). Means were compared using paired and unpaired t-tests. Results Forty-three patients with 46 digits were eligible and were randomized to 1-day (22 digits) and 7-day (24 digits) manipulation. For MCP joints, there were no significant differences in flexion contractures between 1- and 7-day cohorts for initial (47° vs 46°), postmanipulation (0° vs 2°), or 30-day follow-up (1° vs 2°) measurements. Premanipulation, the residual contracture was significantly lower in the 7-day group (23° vs 40°). For PIP joints, there were no significant differences between 1- and 7-day cohorts for initial (63° vs 62°), premanipulation (56° vs 52°), postmanipulation (13° vs 15°), or 30-day (14° vs 16°) measurements. There were no significant differences in pain or skin tears between the 2 groups. No flexor tendon ruptures were observed. Conclusions The effectiveness of CCH in achieving correction of Dupuytren contractures was preserved when manipulation was performed on day 7, with no differences in correction, pain, or skin tears. These data suggest that manipulation can be scheduled at the convenience of the patient and surgeon within the first 7 days after injection.

AB - Purpose To compare the efficacy, tolerance, and safety of manual manipulation at day 7 to day 1 following collagenase Clostridium histolyticum (CCH) injection for Dupuytren contracture. Methods Eligible patients were randomized to manipulation at day 1 versus day 7 following CCH injection. Preinjection, premanipulation, postmanipulation, and 30-day follow-up metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joint contractures were measured. Pain scores were recorded at each time point. Data were stratified per cohort based on primary joint treated (MCP vs PIP). Means were compared using paired and unpaired t-tests. Results Forty-three patients with 46 digits were eligible and were randomized to 1-day (22 digits) and 7-day (24 digits) manipulation. For MCP joints, there were no significant differences in flexion contractures between 1- and 7-day cohorts for initial (47° vs 46°), postmanipulation (0° vs 2°), or 30-day follow-up (1° vs 2°) measurements. Premanipulation, the residual contracture was significantly lower in the 7-day group (23° vs 40°). For PIP joints, there were no significant differences between 1- and 7-day cohorts for initial (63° vs 62°), premanipulation (56° vs 52°), postmanipulation (13° vs 15°), or 30-day (14° vs 16°) measurements. There were no significant differences in pain or skin tears between the 2 groups. No flexor tendon ruptures were observed. Conclusions The effectiveness of CCH in achieving correction of Dupuytren contractures was preserved when manipulation was performed on day 7, with no differences in correction, pain, or skin tears. These data suggest that manipulation can be scheduled at the convenience of the patient and surgeon within the first 7 days after injection.

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KW - timing

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