Collagenase clostridium histolyticum injection in the treatment of dupuytren's contracture: A systematic review

Background: Dupuytren's Contracture is a condition affecting the fascia in hands and fingers causing finger bends in toward the palm. This debilitating disease can affect the activities of daily living. Surgery has been the main stay of treatment, but it is not devoid of complications. Recently, Collagenase Clostridium histolyticum injection has shown better results. There is concern over the efficacy and safety. There is a need for a systematic review that provides high-quality evidence to help surgeons choose the appropriate treatment. Aims: The aim of the study was to assess the effectiveness of the Collagenase Clostridium histolyticum injection by assessing the outcome; correction of deformity, increase in range of movement (ROM) of the finger, and patient satisfaction and also to identify the adverse reactions and recurrence rate. Methods: A systematic review was undertaken. Literature search was done using strict search criteria from electronic databases (MEDLINE, EMBASE, CINAHL, BNI, and Cochrane Library) and trial registers. Two independent authors conducted the study selection, data extraction, and quality assessment of each study. Narrative approach to data synthesis was adopted. Results: Four randomized controlled trials, four observational studies, and two follow-up studies were included. In all the studies, favorable outcomes in deformity correction and increase in ROM were found. Injection treatment had more mild-to-moderate complications which was statistically significant. Conclusion: The review suggests favorable outcome following collagenase injection, especially in metacarpophalygeal joint contractures. More research is needed to assess its efficacy in proximal interphalygeal joints. There is a need for cost analysis between injection and surgical treatment.