Artrodesis de articulación interfalángica proximal en enfermedad de DupuytrenUna revisión sistemática cualitativa

Resumo

Introduction One of the typical features of Dupuytren contracture is its tendency for recurrence. Reintervention surgery has a high rate of complications, which increases with successive surgeries. Repeated fasciectomies can be contraindicated in severe, recurrent contractures, with arterial insufficiency or poor-quality soft tissue, due to a risk of severely compromising the viability of the skin. In these cases, finger amputation can be avoided by performing arthrodesis of the proximal interphalangeal (PIP) joint. Arthrodesis is also an alternative to amputation in contracted fingers affected by arthritis or arthrofibrosis of the PIP joint. Knowledge about this procedure is scarce due to its rarity. We performed a qualitative systematic review of the results and complications of arthrodesis of the PIP joint of digits 2 to 5 in adults with Dupuytren contracture. Materials and Methods Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, we conducted a search on the PubMed, Cochrane and Embase databases. The risk of bias was assessed with the modified Newcastle-Ottawa Scale. We recorded the intraoperative and postoperative variables, and those related to complications, improvement in pain and function, and the level of patient satisfaction. Results For the systematic review, we selected 4 case series totalling 65 patients and 71 arthrodesis. Significant improvements in terms of pain and function were not observed, but, in all studies, patient satisfaction was high. The rate of complication was of 11.3%, and they included 1 case of skin necrosis, but no vascular or nervous lesions were observed. Conclusion Despite the fact that no improvements in pain or function were reported, this procedure is associated with a high level of patient satisfaction, and an extremely low rate of skin ailments or vascular or nervous lesions. The level of evidence regarding the results and complications is low