Article

Randomized clinical trial on 2 patient groups with Dupuytren's
disease. INTRODUCTION: Despite an unpredictable outcome, surgery remains an
important treatment for Dupuytren's disease. Orthotic devices are a controversial
noninvasive treatment method to influence the myofibroblasts in the nodules.
PURPOSE OF THE STUDY: To detect how much improvement
2 types of orthotic device
(tension and compression) as only treatment intervention can provide on a
Dupuytren's contracture. Is a compression orthosis better than a tension orthosis ? METHODS: Thirty patients with measurable flexion contractures of the
fingers were identified. Both primary and recurrence cases were included.
Patients were randomized in 2 groups of 15 patients. One group had a standard
tension orthosis (Levame), the other group a newly designed silicon compression
orthotic device. Patients were instructed to wear the orthotic devices 20 hours a
day during 3 months. Data were collected at first visit and after 3 months of
orthotic treatment. Primary outcomes were active extension deficit of each joint
and total active extension (TAE) of the digit. Secondary outcome was patient
satisfaction. Visual Analog Scale (VAS) score of function and esthetics (0-10
points) were recorded at the start and after 3 months. RESULTS: Flexion
contracture was reduced at least 5 degrees in all patients. After 3 months, TAE
was significantly reduced in both groups (both P < .001).
The mean change in TAE
was 32.36 degrees in the tension group and 46.47 degrees in the compression
group. Although reduction of TAE deficit was bigger in the compression group,
this difference was not statistically significant (P = .39). VAS scale of
esthetics and functionality was significantly increased in both treatment groups.
The functional VAS scale after 3 months was 11% higher in the compression group
than in the tension group (P = .03). A major complication of a tension orthotic
is skin ulcers. DISCUSSION: Too much tension may cause myofibroblast stimulation
and disease progression, whereas continuous limited tension can improve flexion
contractures. The idea of a compression device is based on the treatment concept
of hypertrophic burn scars. CONCLUSION: Tension and compression orthotic devices
can be used as a nonoperative treatment of Dupuytren's disease in both early
proliferative untreated hands and aggressive postsurgery recurrence. Although
there is no statistically significant difference, compression orthoses appear to
be more effective and are better tolerated. Nevertheless, adjustment of orthotic
design and research on long-term results are needed.
LEVEL OF EVIDENCE: I
(Randomized controlled trial, Therapeutic study).
CI - Copyright (c) 2016 Hanley & Belfus. Published by Elsevier Inc. All rights
reserved.

Langue : ANGLAIS