Predictors of Outcomes Following Fasciectomy for Dupuytren's Disease in Diabetic and Non-Diabetic Patients.

BACKGROUND: The aim of this study was to compare clinical outcomes, and identify predictors thereof, after fasciectomy for Dupuytren's disease in a series of diabetic patients compared with non-diabetic patients. METHODS: Thirty-eight patients were examined following partial palmar and/or digital fasciectomy for Dupuytren's disease (11 diabetics, 27 non-diabetics). Each patient was assessed for degree of pre- and post-operative flexion contractures at the MCP and PIP joints, post-operative Patient Evaluation Measure (PEM) total score, post-operative grip strength, limited joint mobility (LJM), recurrence, extension, and a composite outcomes score based upon grip strength and the degree of joint contractures. All measurements in the diabetic cohort were compared to those in the non-diabetic group, and a logistic regression analysis was performed to identify the predictive value of several variables on outcomes. RESULTS: Complication rates between the two groups were statistically similar (p = 0.67). There were no significant differences in pre-operative MCP (p = 0.69), post-operative MCP (p = 0.39), pre-operative PIP (p = 0.40), or post-operative PIP (p = 0.13) joint flexion contractures between the two groups. Additionally, there was no significant difference in extension (p = 0.35) or recurrence (p~1) rates, post-operative grip strengths (p = 0.64), or PEM total scores (p = 0.32). However, the rate of LJM was significantly higher in the diabetic population (p = 0.02). Both female gender (p = 0.01) and a non-smoking status (p = 0.04) were found to be predictive of better outcomes following fasciectomy. Diabetes was not found to be an independent predictor of outcome (p = 0.73). CONCLUSIONS: Clinical results after fasciectomy for Dupuytren's disease in diabetic patients are not different from results obtained in non-diabetic patients. Diabetes is not independently predictive of surgical outcomes. Female gender and non-smoking status are independent predictors of a better outcome following fasciectomy.

[Hand disorders in diabetic patients].

Some commonly encountered hand disorders such as trigger finger, carpal tunnel syndrome and Dupuytren's contracture occur up to 4 times more frequently in diabetic patients, affecting their activity and decreasing the quality of their life. The natural history of these disorders in diabetic patients and the outcome of treatment may not be the same as in the general population. Furthermore, some patients develop hand problems due to limited joint mobility. In this article, the authors review epidemiologic aspects as well as therapeutic considerations and outcomes of these hand disorders in diabetics.