Dupuytren contracture

Description

Dupuytren contracture: A gradual thickening and tightening of the fascia (fibrous tissues layer) under the skin of the palm and fingers in the hand.


History

1822Sir Astley Cooper (1768-1841) reported digital contractures, and deemed them ‘incurable by operation

1831Dupuytren first to realise that the basic ‘lesion‘ for contracture lay in the palmar fascia rather than the skin or tendons. He operated on the contracture of a French wine merchant (1811) with success, taking a swipe at AP Copper at the same time

1833Jean-Gaspard-Blaise Goyrand (1793-1866) presented at l’Academie Royale de Médecine, claiming Dupuytren was in error on three points:

  • Dissections showed bands flexing fingers and the thumb, beyond the normally accepted limits of the palmar aponeurosis
  • A longitudinal incision allowed better healing and even some fascial excision (possibly the first fasciectomy)
  • The condition was more hereditary than occupational in origin

1835 – Goyrand demonstrated that excision of a transverse segment of palmar aponeurosis and direct suture of this defect will produce flexion only at the MP and not at the IP joints. Goyrand proposed that the ‘predigital bands‘ which flexed the fingers, were formed from the ‘fibro-cellular subcutaneous tissue‘ of the fingers. This ‘extrinsic‘ theory of aponeurotic retraction origin directly opposed the ‘intrinsic‘ theory of Dupuytren – A concept supported by the work of Velpeau (who claimed priority…).


Associated Persons


Alternative names

  • Dupuytren’s disease
  • Palmar fibromatosis

Controversies

Sir Astley Cooper (1768-1841) had previously reported digital contractures, but deemed them “incurable by operation


References

  • Dupuytren G. De la rétraction des doigts par suite d’une rétraction de l’aponévrose palmaire. Paris, 1831, 2nd series; 5: 352-365.
  • Dupuytren G. Permanent retraction of the fingers, produced by affection of the palmar fascia. Lancet, London, 1833-1834, 2: 222-225. English translation and reprint in Medical Classics, 1939, 4: 142-150
  • Goyrand G. Nouvelles recherches sur la rétraction permanente des doigts. Mem R Méd Belg, 1833, 3: 489-196.
  • Goyrand G. De la ritraction permanente des doigts. Gazette Medicale de Paris 1835, 2s 3: 481-486.
  • Peltier LF. Guillaume Dupuytren and Dupuytren’s fracture. Surgery. 1958;43(5):868-74. [PMID 13543661]
  • Battaloglu E, Deshmukh RG. Dupuytren’s contracture: Current understanding of the condition and its management. Hard Tissue 2014 Feb 10;3(1):3
  • Gilgenkrantz S. [The Baron Guillaume Dupuytren]. Med Sci (Paris). 2006 Aug-Sep;22(8-9):771-2.[PMID16962055] [PDF]
  • Gudmundsson KG, Jónsson T, Arngrímsson R. Guillaume Dupuytren and finger contractures. Lancet. 2003 Jul 12;362(9378):165-8. [PMID12867120] [Full Text]
  • Gudmundsson KG, Arngrímsson R, Sigfússon N, Björnsson Á, and Jónsson T. Epidemiology of Dupuytren’s disease: clinical, serological and social assessment. The Reykjavik Study. J Clin Epidemiol. 2000; 53: 291–296 [Full Text]
  • Elliot D. The Early History of Contracture of the Palmar Fascia – Part 3: The controversy in Paris and the spread of surgical treatment of the disease throughout Europe. Journal of Hand Surgery . Volume: 14 issue: 1, page (s): 25-31 [Reference]

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Emergency physician MA (Oxon) MBChB (Edin) FACEM FFSEM with a passion for rugby; medical history; medical education; and informatics. Asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | Eponyms | Books | vocortex |

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