111. A Long-term Comparison of Collagenase versus Fasciectomy in the Treatment of Dupuytren’s Contracture

PURPOSE: Dupuytren’s disease (DD) is one of the most common disorders of the hand, affecting 5.7-11.7% of the global population. This study seeks to evaluate the long-term efficacy of the two most prominent treatment modalities, injectable collagenase Clostridium histolyticum versus open fasciectomy. We hypothesize that those who had an open fasciectomy to treat their contracture will have significantly less recurrence, greater degree of deformity improvement, and fewer procedural interventions in the long-term. METHODS: We conducted a retrospective review of all electronic medical records of patients who underwent open fasciectomy or collagenase injection to treat their persistent Dupuytren’s contracture between April 2011 and April 2021. All procedures were performed by one of five senior surgeons at the same Veterans Affairs Hospital hand surgical center. Therapeutic administration and documentation for both fasciectomy and collagenase injection patients were managed by a single licensed hand therapist. RESULTS: Two hundred and thirty-two patients were treated for DD, with 247 collagenase injections and 44 open fasciectomies performed in this sample. The average time from collagenase injection until review was 6.51 years, with 162 patients followed for more than 5 years. The average time from open fasciectomy until review was 4.56 years, with 12 patients followed for more than 5 years. The average decrease in flexion deformity was significantly different between groups; collagenase decreased contractures on average by 29.40°, whereas open fasciectomy decreased contractures on average by 38.59° (P < 0.001). The frequency of contracture resolution across all joints was significantly lower in the collagenase group compared to the fasciectomy group, with 38.18% (155 of 406 treated joints) vs 70.0% (56 of 80 treated joints) of contractures resolved, respectively (P < 0.001). A significant difference was observed in the rate of recurrence after resolution between groups; of the contractures that were initially classified as resolved, 50 of 155 (32.2%) treated with collagenase and 6 of 56 (10.7%) treated with open fasciectomy recurred (P = 0.0017). In a multivariate binary logistic regression, use of open fasciectomy to treat contracture was associated with a 74.2% decrease in the likelihood of recurrence (P = 0.014). CONCLUSION: This study found that treatment of DD with collagenase injection is associated with a significantly lower degree of deformity correction, lower rate of resolution, and increased rate of recurrence, prolonging treatment trajectory when compared to open fasciectomy. Future studies should continue to build on the existing follow-up periods currently in the literature to assist surgeons in selecting a long-term efficacious treatment modality for DD.