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Collagenase injections are more expensive but require fewer treatments than percutaneous needle fasciotomy to achieve the same results
17%
643/3778
Softening of Dupuytren cords and nodules is observed in cadaveric experiments after collagenase injections but not in a clinical setting
4%
157/3778
Skin tears are seen following percutaneous needle fasciotomy but not after collagenase injections
3%
100/3778
Pruritic rash and axillary lymphadenopathy may be observed after collagenase injections but are not typically seen after percutaneous needle fasciotomy
58%
2199/3778
Percutaneous needle fasciotomy has a higher incidence of iatrogenic flexor tendon rupture
641/3778
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Pruritic rash and axillary lymphadenopathy is particular only to collagenase injections (CI). These reactions do not occur after percutaneous needle fasciotomy (PNF).Regional subtotal fasciectomy is the gold standard of care for treatment of Duyputren's contracture. However, because of high complication rates (up to 40%), nonoperative treatments are attractive. In PNF, a 22G or 25G needle is used to release palpable/visible cords in the office. This is followed by manipulation, and night orthosis wear. In CI, 0.25ml of collagenase is used for MCP contracture and 0.20ml for PIP contracture. Manipulation is performed the following day under local anesthesia. This is repeated at 4 weeks if the desired result is not achieved.Black et al. reviewed Dupuytren's disease. They note that recurrence rates were higher for PNF (85%) compared with fasciectomy (24%) and conclude that PNF is acceptable for early disease with less severe contracture and elderly, sick patients. Regarding CI, they note that the most common complications are edema, contusion, pain, lymphadenopathy, and skin laceration. Major complications, such as complex regional pain syndrome and flexor tendon rupture, are rare.Nydick et al. retrospectively compared PNF (30 patients) with CI (29 patients). Both groups achieved similar satisfaction, complication rates, and success rates defined as contracture reduction to 0-5 degrees. They concluded that both PNF and CI provide good alternatives to surgery.Incorrect Answers:Answer 1: Collagenase injections are more expensive and more injections are needed to achieve the same results as PNF.Answer 2: Softening of Dupuytren cords and nodules is seen in the clinical setting and is one of the reported short term advantages of CI.Answer 3: Skin tears are a result of forceful manipulation following either CI or PNF, and not a result of the injection or fasciotomy per se. Skin tears are therefore a complication of both treatments.Answer 5: No major complications such as tendon rupture, nerve, or vessel injury were observed in either group in the Nydick et al study.
2.5
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