Treatment of Dupuytren Disease With Injectable Collagenase in a Veteran Population: A Case Series at the Department of Veterans Affairs New Jersey Health Care System

INTRODUCTION Clinical trials seeking to establish long-term efficacy of injectable collagenase clostridium histolyticum for treatment of Dupuytren disease are ongoing. In this quality improvement study, the efficacy, recurrence rate, and complications of collagenase injection for Dupuytren disease are reviewed in a population of Veteran patients. MATERIALS AND METHODS A retrospective chart review was performed for patients who underwent treatment with injectable collagenase for Dupuytren disease from 2010 to 2013 at our regional Department of Veterans Affairs medical center. Data points of interest included the degree of joint contracture preoperatively, immediately after treatment, and at follow-up, complications, and patient satisfaction. RESULTS Sixteen patients received 27 injections (18 metacarpophalangeal and 9 proximal interphalangeal injections). The mean time of follow-up was 12.3 months. There was a 50% or greater reduction of the original extension deficit in 74.1% (n = 27) of the joints treated. Metacarpophalangeal joint recurrence was "high" (≥50°) in 0% (n = 18) of joints, and "low" (5°-50°) in 33.3% (n = 18) of joints with a mean follow-up of 12 months. Proximal interphalangeal joint recurrence was "high" (≥40°) in 18.5% (n = 9) of joints and "low" (5°-40°) in 7.4% (n = 9) of joints with a mean follow-up of 12.9 months. Minor complications were experienced in 93.8% (n = 16) of patients who underwent collagenase injection and included ecchymosis, skin laceration, injection-site swelling, injection-site hemorrhage, tenderness, and pruritus. Seventy-five percent (n = 12) of patients in our study reported they would undergo treatment with collagenase again. CONCLUSIONS The case series presented demonstrates that injectable collagenase clostridium histolyticum produced a clinical success rate of 74.1% and is a safe method to treat Dupuytren disease.