Dupuytren’s contracture of hand and its medical and social review
DOI:
https://doi.org/10.14739/2310-1210.2014.1.23644Keywords:
hand, Dupuytren’s contracture, medical and social examinationAbstract
Introduction
Dupuytren's contracture is a disease of connective tissue with the affection of palmar aponeurosis, frequently with chronic recurrent course, the flexion deformities of fingers and dysfunction of the hand. It composed 11,8 % among of all types of the hand pathology. The mostly it develops in men of middle-aged and elderly. At young age it occurs more rarely, but with fast progressing current, which in 67 % of cases leads to impaired ability to perform professional hand-work and in 3 % patients to physical inability. Predisposing factors for this fibromatosis are numerous, but one of the popular opinion among of authors is a hereditary character of disease. In clinical practice, the most frequently used fourth degree’s classification of Dupuytren's contracture includes severity of deformation and function disorders of the hand. It is correspond to the normative standards of medical and social expertise
The aim of research: to specify the most optimal methods of surgical treatment, the criteria of medical and social examination and rehabilitation, clinical and labor prognosis, indications to establishment of disability after operations concerning of Dupuytren’s contracture.
In our clinic was performed three methods of operation: aponeurotomia “open hand”, partial aponeuroectomia, total aponeuroectomia. Errors in the treatment of palmar fibromatosis we shared on: preoperated, intraoperated and associated with violations of the mode of rehabilitation. The next clinical observation of 68 patients (up to 3 years after surgery) with Dupuytren’s contracture of hand showed the recurrence rate amounted to 31,7%, and physical inability level is 5,9% of cases. In our opinion the most optimal operative methodic is total aponeuroectomia with rational surgical approaches.
Clinical and labour prognosis depends on the manifestations of disease which can develop regardless of the stage, methods of treatment and patient's age. Disadvantageous prognostic factors include: the formation of keloid scars, persistent development of contractures and arthritis of the joints of fingers. For the expert diagnosis, the most important are functional disorders such as the capture and retention of items. Other types of disorders are less important. The restriction of mobility little joints with vicious position of fingers of the hand limit the ability to work and ability to self-service. The case of the bilateral affected leads to disability group III.
At carrying out of medical and social examination and its conclusion, it is necessary to take into account the age, concomitant pathology, compensatory abilities of the patient, as well as the dynamics of recovery function of the hand after correction.
Conclusions:
- Dupuytren’s contracture is the complex orthopedic pathology that can be interpreted as dysplasia of connective tissue. It makes 11,8% of all diseases of hand and affects mainly men of the middle age.
- In clinical practice is most often applied four-degree’s classification considering severity of deformation and function disorders of hand, which needs clarification of criteria for medical and social examination.
- The optimal method of Dupuytren’s contracture treatment is operative – the total aponeuroectomia, however the quantity of unsatisfactory outcomes reaches 13 % of cases, and cases on physical inability up to 3 %. According to our clinical observation of the 68 patients (up to 3 years after surgery) the recurrence rate amounted to 31,7%, and physical inability level is 5,9% of cases.
- In our opinion, aponeuroectomia should be regarded as complex microsurgical operation, by using rational approaches and obligatory plastic substitution of the defects of the skin.
- The basic criteria of the clinical and labor prognosis and medical and social examination are characters of morphological changes and a degree of the basic functions disorders of hand. They reduce work capacity, quality of life, and at bilateral affection results to ІІІ group of physical inability and to 1-st degree of disability. At conclusions of medical and social examination it is necessary to consider compensatory possibilities of the person and concomitant pathology, as well as its profession and age.
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