Dupuytren's contracture M72.0

Accumulation in the Nordic cultural area (Scandinavia, Northern Germany). The prevalence is 1-17% in western cultural countries: The highest prevalence is in Africa 17%. Asia 15%. Europe 10%, America 2%.

Genetic factors cause 80% of the factors, partly autosomal-dominant inheritance, reduced penetrance and variable expressivity is assumed. Other causes include trauma, long-term work with vibrating equipment (> 15 years), liver disease, diabetes mellitus, smoking with concomitant alcohol consumption, epilepsy or dialysis. Pathogenetically, increased local production of interleukin-1, basic fibroblast growth factor, and "transforming growth factor beta" lead to local proliferation of fibroblasts and overproduction of collagen. The transformation of fibroblasts into contractile myofibroblasts and impaired apoptosis lead to contractures in the course of the disease.

Mostly in men in middle to later age. Men are affected 5-10 times more often than women.

Depending on the characteristics, a distinction is made between 4 stages:

• 1st degree: circumscribed, palpable node formation
• 2nd degree: incipient contracture, minor obstruction of finger extension in the metacarpophalangeal joint
• 3rd degree: Stretch impediment in the middle or base joint
• 4th degree: Additional hyperextension in the final joint and finally bending contracture of the fingers >135º.

Mostly unilateral, rarely double-sided pressure or spontaneously painful nodular hardening of the palmar aponeurosis near the joint; bending contracture of the ulnar fingers. Depending on the examiner, combinations with the following fibromatoses occur in about 5%:

• Induratio penis plastica (Peyronie's disease)
• Fibrosis mammae virilis
• Ledderhose disease (plantar fibromatosis)

In addition, the occurrence of keloids, cirrhosis of the liver, "knuckle pads" or periarthritis humeroscapularis was observed.

Recurrence rate after limited fasciectomy: 12-73% after 5 years; percutaneous needle fasciotomy: 85% after 2.3 years.

As prophylaxis in case of high familial risk or postoperatively in case of high risk of recurrence radiotherapy is to be considered.

Therapy of Dupuytren's contracture

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