Professional Documents
Culture Documents
WHATS CERTAIN
Genetic trait
Caucasian (3-6%); 8 cases over 6 years in a black
population with an incidence of 0,00007%
Sporadic cases in asiatic people (595 cases- 96 chineses,
19 thais, 1 vietnam, 15 india, 474 Japan - age 67 yrs, familial history
9% - Risk factors 65%)
WHATS CERTAIN
Links to other pathologies
Diabetes - OR 1,75 - type I > 2
Epilepsia - OR 1,12
Tobacco - OR 2,8
Alcohol - OR 1,9
Others: HIV, Hypertriglyceridemia, work, ...
Loos, BMC 2007;8:60 ; Geoghegan JHS 2004; 29B: 423-426 ; Burge JBJS 1997; 79B: 206-210
WHATS CERTAIN
Unpredictable evolution after
surgery
Reccurences will occur if the patient
lives long enough
Surgical complications should be
limited if possible (per-op ; early ;
late complications)
Nerve and arterial injuries
(1-1,5%Skin tears, skin necrosis (5-10%),
RSD, Flare reaction (5-10%)
CONSERVATIVE TREATMENT
Observation ?
Nodules followed-up for 9 years
CONSERVATIVE TREATMENT
Have been abandoned: cytolytic agents,
Radiotherapy (Keilholz, 1996), Interferon,...
Not validated: acupuncture, mesotherapy,
homeopathy, vit E (Thomson, 1949), phytotherapy,
physiotherapy (Stiles, 1966),...
Had proven not useful: Steroid injection (Baxter, 1952; Ketchum,
2001), Allopurinol,
Yet to be proven: Isoptine, Imiquimod (Namazi. Med Hypotheses.
2006;66(5):991-2.), shockwave therapy (Knobloch. Med Hypotheses 2011;76(5):
635-7), Antifibrotics (Knobloch. Med Hypotheses 2009; 73(5):659-61),...
HISTORICAL OF NEEDLE
APONEUROTOMY
De Seze & Debeyre: 1957, Rev Rhum - 70 cases
Lermusiaux: 1984, Rev Prat.
Badois: 1993, Rev. Rhum.
Lermusiaux: 1997, Rev. Rhum.
Foucher: 1998, Ann. Chir. Plast. -2001, Chir. Main
NEEDLE APONEUROTOMY
ORIGINAL TECHNIQUE
Done during consultation
Local anesthesia
Steroid Injection into nodules under pressure
To and Fro mvts with a fine needle
Finger extension - mechanical rupture
Extension splint
2 SESSIONS
MULTIPLE APONEUROTOMY
SURGICAL TECHNIQUE
Stage
Finger
36
2 + 17 W1
91
22
17
18
78
25
COMPLICATIONS
Tendon
Nerve
Infectious 1
RSD
Stiffness
Pain
84%
Minimal
76%
Severe 8%
> 1 month 6%
CUTANEOUS COMPLICATIONS
Ruptures
57%
11%
2
EVOLUTION OF RESULTS
3 yrs
5,5 yrs
Reccurence
38 (22,7%)
66 (39,5%)
No TTT
29 (17,4%)
42 (25,1%)
TTT
9 (5,4%)
24 (14,4%)
Aponeurotomie
7 (4,2%)
9 (5,4%)
Fasciectomy
2 (1,2%)
17 (10,2%)
CONTRA-INDICATIONS ?
The thumb
Nodules, skin infiltration
HOW SAFE IS IT ?
No complications (8 cases - Cheng J Orthop Surg 2008; 16(1):
88-90 / 74 cases van Rijssen. JHS Br 2006;31(5):
498-501)
1 nerve injury (211 cases - Foucher Chir Main 2001;20(3):
206-11
HOW EFFICIENT IS IT ?
IS IT BETTER ?