Contracture on palm

            Identify the problem. 



Answer - 



    The first photograph shows flexion of ring and little finger at             MCP    joints of both the hands suggestive of Dupuytren's                  contracture. 


    The second picture is a post operative picture following                        segmental Fasciectomy.


Some points worth to know about this condition

Risk Factors 
    Positive Family History
      Liver Diseases 
      High Alcohol Intake 
      Diabetes Mellitus 
      Epilepsy 

Histology 
    Myofibroblasts 
   Thick Collagen Fibres 

Management 

  A. Non operative 
        - Night time splinting
        - Injections 
                a. Steriods- reduces local tenderness
                b. Collagenase
                    
    B. Operative 
    
        - Percutaneous Fasciotomy 
        - Segmental/ Palmar Fasciectomy 
        - Regional Fasciectomy 
        ( Z plasty for closure/skin grafting )
        - Dermofasciectomy and skin grafting
        - PIP Joint Arthrodesis for severe and recurrent cases
        - Amputation of digits 

Patient Counselling 

      - Delayed wound healing             

       - Tendon, nerve, vessel injuries

        - Temporary or permanent numbness

        - Necrosis of digit and amputation

        - Incomplete correction

        - Recurrence and reoperation 

        - Joint stiffness

        - Reduced flexion/ extension at PIP Joint 

        -  CRPS 



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