Elsevier

The Journal of Hand Surgery

Volume 31, Issue 10, December 2006, Pages 1626-1634
The Journal of Hand Surgery

Dupuytren’s contracture
Dupuytren’s Diathesis Revisited: Evaluation of Prognostic Indicators for Risk of Disease Recurrence

https://doi.org/10.1016/j.jhsa.2006.09.006Get rights and content

Purpose

The term diathesis relates to certain features of Dupuytren’s disease (DD) and dictates an aggressive course of disease. The initial description of DD diathesis included 4 factors: (1) ethnicity, (2) family history, (3) bilateral DD, and (4) ectopic lesions (DD outside the palm). The degree of diathesis is considered important in predicting recurrence and extension of DD after surgical management. Prognostic indicators of risks associated with surgery are important. We aimed to evaluate these 4 factors and known associated risk factors to formulate a statistical predictive value for DD diathesis.

Methods

Caucasian patients diagnosed with DD between the ages of 25 and 90 years (n = 322) from Northwest England were assessed for DD diathesis with a clinical history and examination. DD diathesis assessment was analyzed by calculating the odds ratios of developing recurrent DD using logistic regression.

Results

The observed recurrence rates in the presence of notable risk factors and corresponding odds ratios of recurrent DD were calculated. Of note, recurrent disease was observed in 121 (46%) males, 105 (47%) with bilateral DD, 68 (48%) with a family history of DD, 75 (47%) with age at onset younger than 50 years, 35 (52%) in those with ectopic lesions, and in 26 (63%) with Garrod’s pads.

Conclusions

The original DD diathesis factors have been evaluated and modified. The original factors of family history, bilateral DD, and ectopic lesions now include 2 additional factors: male gender and age at onset of younger than 50 years. Family history and ectopic disease have now been modified to specify family history with one or more affected siblings/parents and ectopic lesions in the knuckles (Garrod’s pads) alone. The presence of all new DD diathesis factors in a patient increases the risk of recurrent DD by 71% compared with a baseline risk of 23% in those DD patients with none of the earlier-described factors.

Type of study/level of evidence

Prognostic II.

Section snippets

Study Sample

A hospital-based, retrospective, cohort study design was used to recruit patients with a diagnosis of DD. All patients were enrolled after surgical management for DD, ensuring that the diagnosis of DD was accurate. The presence of DD nodules, cords in the palmar or plantar fascia, with or without contraction of affected digits on examination, was used to confirm the diagnosis. A total of 322 Caucasian patients diagnosed with DD were identified via surgical records from a hospital in the

Observations

Of the 322 patients, 141 (44%) had recurrent (true recurrence) DD. Each patient had a fasciectomy for treatment of DD. The frequency of observed associated risk factors in all patients was documented (Table 1). Of note, ectopic lesions were found in 77 (24%) patients. There was no Peyronie’s disease, 41 (13%) had Garrod’s pads, and 36 (11%) had Lederhose’s lesions. Bilateral palmar DD lesions were apparent in 225 (70%) patients. A family history was reported by 143 (44%) patients. The mean age

Discussion

The odds ratio and predictive risk for developing recurrent DD after surgical management has been derived with an implication to modify the current DD diathesis. Patients with features of DD diathesis are at high risk for developing recurrence after treatment. In this study we observed true and false recurrences; those patients with a true recurrence and not a false recurrence or extension of DD were considered to have recurrent DD after surgical treatment.

It has been suggested that those with

References (38)

  • J.T. Hueston

    Unsatisfactory results in Dupuytren’s contracturePhilosophies of Dr. J. T. Hueston

    Hand Clin

    (1991)
  • S. Hindocha et al.

    The heritability of Dupuytren’s disease: familial aggregation and its clinical significance

    J Hand Surg

    (2006)
  • K.G. Gudmundsson et al.

    Epidemiology of Dupuytren’s disease: clinical, serological, and social assessmentThe Reykjavik study

    J Clin Epidemiol

    (2000)
  • O.A. Mikkelsen

    Knuckle pads in Dupuytren’s disease

    Hand

    (1977)
  • A. Bayat et al.

    Management of Dupuytren’s disease—clear advice for an elusive condition

    Ann R Coll Surg Engl

    (2006)
  • A.J. Thurston

    Dupuytren’s disease

    J Bone Joint Surg

    (2003)
  • J.T. Hueston
  • F. Iselin

    Recurrences in Dupuytren’s contracture

  • A.W. Lettin

    Dupuytren’s diathesis; a case report

    J Bone Joint Surg

    (1964)
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