{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T20:09:53Z","timestamp":1777061393957,"version":"3.51.4"},"reference-count":52,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2022,3,1]],"date-time":"2022-03-01T00:00:00Z","timestamp":1646092800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Background: While surgical therapy for Dupuytren\u2019s disease is a well-established standard procedure, severe joint flexion deformities in advanced Dupuytren\u2019s disease remain challenging to treat. Skeletal distraction has proven to be an additional treatment option. Methods: We analyzed the surgical treatment algorithm, including the application of a skeletal distraction device, in patients with a flexion deformity due to Dupuytren\u2019s disease, Iselin stage III or IV, who were operated on from 2003 to 2020 in our department. Results: From a total of 724 patients, we included the outcome of 55 patients\u2019 fingers in this study, who had undergone additional skeletal joint distraction with our Erlangen device. Additional fasciotomy or fasciectomy, in a one- or two-staged procedure, was performed in all patients, according to the individual findings and necessities. The range of motion of the PIP joint improved from 12\u00b0 to 53\u00b0. A number of complications, in all steps of the treatment, were noted in a total of 36.4% of patients, including the development of fractures (16.4%), followed by vessel injury, pin infections, and complex regional pain syndrome (5%). Conclusions: Additional skeletal distraction improves the range of motion of severely contracted joints in Dupuytren\u2019s disease. Nevertheless, careful patient selection is necessary, due to the moderate rate of complications.<\/jats:p>","DOI":"10.3390\/jpm12030378","type":"journal-article","created":{"date-parts":[[2022,3,1]],"date-time":"2022-03-01T21:25:14Z","timestamp":1646169914000},"page":"378","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["A Personalized Approach to Treat Advanced Stage Severely Contracted Joints in Dupuytren\u2019s Disease with a Unique Skeletal Distraction Device\u2014Utilizing Modern Imaging Tools to Enhance Safety for the Patient"],"prefix":"10.3390","volume":"12","author":[{"given":"Wibke","family":"M\u00fcller-Seubert","sequence":"first","affiliation":[{"name":"Department of Plastic and Hand Surgery, Friedrich-Alexander-University Erlangen-N\u00fcrnberg (FAU), Krankenhausstr. 12, 91054 Erlangen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8738-9298","authenticated-orcid":false,"given":"Aijia","family":"Cai","sequence":"additional","affiliation":[{"name":"Department of Plastic and Hand Surgery, Friedrich-Alexander-University Erlangen-N\u00fcrnberg (FAU), Krankenhausstr. 12, 91054 Erlangen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2473-5816","authenticated-orcid":false,"given":"Andreas","family":"Arkudas","sequence":"additional","affiliation":[{"name":"Department of Plastic and Hand Surgery, Friedrich-Alexander-University Erlangen-N\u00fcrnberg (FAU), Krankenhausstr. 12, 91054 Erlangen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ingo","family":"Ludolph","sequence":"additional","affiliation":[{"name":"Department of Plastic and Hand Surgery, Friedrich-Alexander-University Erlangen-N\u00fcrnberg (FAU), Krankenhausstr. 12, 91054 Erlangen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Niklas","family":"Fritz","sequence":"additional","affiliation":[{"name":"Department of Plastic and Hand Surgery, Friedrich-Alexander-University Erlangen-N\u00fcrnberg (FAU), Krankenhausstr. 12, 91054 Erlangen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6561-2353","authenticated-orcid":false,"given":"Raymund E.","family":"Horch","sequence":"additional","affiliation":[{"name":"Department of Plastic and Hand Surgery, Friedrich-Alexander-University Erlangen-N\u00fcrnberg (FAU), Krankenhausstr. 12, 91054 Erlangen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,3,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Loos, B., Puschkin, V., and Horch, R.E. (2007). 50 years experience with Dupuytren\u2019s contracture in the Erlangen University Hospital\u2014A retrospective analysis of 2919 operated hands from 1956 to 2006. BMC Musculoskelet. Disord., 8.","DOI":"10.1186\/1471-2474-8-60"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"329","DOI":"10.5455\/medarh.2012.66.329-331","article-title":"Results of surgery treatment of Dupuytren\u2019s contracture in 115 patients","volume":"66","author":"Karabeg","year":"2012","journal-title":"Med. Arch."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1016\/S0894-1130(02)80004-7","article-title":"A clinical report of the effect of mechanical stress on functional results after fasciectomy for dupuytren\u2019s contracture","volume":"15","author":"Evans","year":"2002","journal-title":"J. Hand Ther."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1125","DOI":"10.1053\/jhsu.2001.28428","article-title":"Emergency microsurgical revascularization for critical ischemia during surgery for Dupuytren\u2019s contracture: A case report","volume":"26","author":"Jones","year":"2001","journal-title":"J. Hand Surg. Am."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/S0094-1298(20)30472-7","article-title":"Recurrence and other complications in surgery of Dupuytren\u2019s contracture","volume":"8","author":"Tubiana","year":"1981","journal-title":"Clin. Plast. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"161-viii","DOI":"10.1016\/S0749-0712(21)00448-0","article-title":"Complications of the operative treatment of Dupuytren\u2019s disease","volume":"15","author":"Boyer","year":"1999","journal-title":"Hand Clin."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1016\/S0363-5023(96)80035-9","article-title":"Microvascular solution for vascular complication in surgery for Dupuytren\u2019s contracture: A case report","volume":"21","author":"Chung","year":"1996","journal-title":"J. Hand Surg. Am."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1007\/s00132-017-3387-5","article-title":"Operative treatment of Dupuytren\u2019s contracture: Arthrolysis of the proximal interphalangeal finger joint","volume":"46","author":"Hohendorff","year":"2017","journal-title":"Der Orthop."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"684","DOI":"10.1016\/j.jhsa.2013.01.038","article-title":"The effect of a therapy protocol for increasing correction of severely contracted proximal interphalangeal joints caused by dupuytren disease and treated with collagenase injection","volume":"38","author":"Skirven","year":"2013","journal-title":"J. Hand Surg. Am."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1016\/j.hansur.2018.12.003","article-title":"Middle phalangectomy with shortening fusion of the fifth finger in Dupuytren\u2019s digital hooks","volume":"38","author":"Raimbeau","year":"2019","journal-title":"Hand Surg. Rehabil."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Eiriksdottir, A., and Atroshi, I. (2019). A new finger-preserving procedure as an alternative to amputation in recurrent severe Dupuytren contracture of the small finger. BMC Musculoskelet. Disord., 20.","DOI":"10.1186\/s12891-019-2701-2"},{"key":"ref_12","first-page":"309","article-title":"Dupuytren\u2019s contracture\u2014Surgery of recurrencies","volume":"37","author":"Estermann","year":"2005","journal-title":"Handchir. Mikrochir. Plast. Chir."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1007\/s00132-017-3385-7","article-title":"Treatment of recurrent Dupuytren\u2019s disease","volume":"46","author":"Pillukat","year":"2017","journal-title":"Orthopade"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1055\/s-2002-32305","article-title":"Die pr\u00e4operative intermittierende pneumatische Dehnungsbehandlung bei ausgepr\u00e4gter Dupuytrenscher Kontraktur [Preoperative Intermittent Pneumatic Soft-Tissue Distraction in Patients with severe Dupuytren\u2019s Contracture]","volume":"34","author":"Beyermann","year":"2002","journal-title":"Handchir. Mikrochir. Plast. Chir."},{"key":"ref_15","first-page":"33","article-title":"Preoperative intermittent pneumatic extension treatment stage III and IV Dupuytren contracture","volume":"32","author":"Herczeg","year":"2000","journal-title":"Handchir. Mikrochir. Plast. Chir."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1097\/00000637-199804000-00010","article-title":"Use of a multiplanar distracter for the correction of a proximal interphalangeal joint contracture","volume":"40","author":"Kasabian","year":"1998","journal-title":"Ann. Plast. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1177\/1558944718822086","article-title":"Proposal for Treatment of Severe Dupuytren Disease in 2 Steps: Progressive Distraction With External Fixator and Collagenase\u2014A Preliminary Case Series","volume":"15","author":"Corain","year":"2020","journal-title":"HAND"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1055\/s-2002-32309","article-title":"Presentation of a simple method of preoperative soft-tissue distraction in Dupuytren\u2019s contracture grade IV","volume":"34","author":"Wulke","year":"2002","journal-title":"Handchir. Mikrochir. Plast. Chir."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"99e","DOI":"10.1097\/PRS.0b013e31817d653b","article-title":"Skeletal traction treatment of severe finger contracture: A new innovative skeletal distraction device","volume":"122","author":"Loos","year":"2008","journal-title":"Plast Reconstr. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1016\/0266-7681(94)90222-4","article-title":"The use of skeletal traction to correct the flexed PIP joint in Dupuytren\u2019s disease. A pilot study to assess the use of the Pipster","volume":"19","author":"Hodgkinson","year":"1994","journal-title":"J. Hand Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"728","DOI":"10.1177\/1753193412439673","article-title":"Management of severe Dupuytren\u2019s contracture of the proximal interphalangeal joint with use of a central slip facilitation device","volume":"37","author":"White","year":"2012","journal-title":"J. Hand Surg. Eur. Vol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1097\/00006534-199307000-00012","article-title":"The continuous elongation treatment by the TEC device for severe Dupuytren\u2019s contracture of the fingers","volume":"92","author":"Messina","year":"1993","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1302\/0301-620X.80B1.0800126","article-title":"The use of skeletal traction in the treatment of severe primary Dupuytren\u2019s disease","volume":"80","author":"Citron","year":"1998","journal-title":"J. Bone Jt. Surg. Br."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1177\/1753193419865716","article-title":"Two-stage treatment of severe Dupuytren\u2019s contracture with an external fixator","volume":"45","author":"Zolotov","year":"2020","journal-title":"J. Hand Surg. Eur. Vol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1107","DOI":"10.1097\/PRS.0b013e31822b67c9","article-title":"Preliminary soft-tissue distraction versus checkrein ligament release after fasciectomy in the treatment of dupuytren proximal interphalangeal joint contractures","volume":"128","author":"Craft","year":"2011","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1597","DOI":"10.1016\/j.jhsa.2015.04.036","article-title":"Dupuytren Contracture Recurrence Following Treatment With Collagenase Clostridium histolyticum (CORDLESS [Collagenase Option for Reduction of Dupuytren Long-Term Evaluation of Safety Study]): 5-Year Data","volume":"40","author":"Peimer","year":"2015","journal-title":"J. Hand Surg. Am."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"919","DOI":"10.1016\/j.jhsa.2019.07.017","article-title":"Outcomes and Direct Costs of Needle Aponeurotomy, Collagenase Injection, and Fasciectomy in the Treatment of Dupuytren Contracture","volume":"44","author":"Leafblad","year":"2019","journal-title":"J. Hand Surg. Am."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1471","DOI":"10.1007\/s00402-019-03247-y","article-title":"Analysis of recurrence and complications after percutaneous needle fasciotomy in Dupuytren\u2019s disease","volume":"139","author":"Moog","year":"2019","journal-title":"Arch. Orthop. Trauma. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e929814","DOI":"10.12659\/MSM.929814","article-title":"External Screw-Threaded Traction Device Helps Optimize Finger Joint Mobility in Severe Stage III and IV Dupuytren Disease","volume":"27","author":"Horch","year":"2021","journal-title":"Med. Sci. Monit."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"932","DOI":"10.1111\/iwj.13639","article-title":"Novel imaging methods reveal positive impact of topical negative pressure application on tissue perfusion in an in vivo skin model","volume":"18","author":"Roth","year":"2021","journal-title":"Int. Wound J."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Promny, D., Gr\u00fcner, J., Hauck, T., and Horch, R.E. (2022). Paradoxical Perfusion Reaction of the contralateral Hand after Hand MRI. Handchir. Mikrochir. Plast. Chir.","DOI":"10.1055\/a-1738-9906"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1016\/j.bjps.2021.08.002","article-title":"Leaving the perfusion zones? Individualized flap design in 100 free DIEP and ms-TRAM flaps for autologous breast reconstruction using indocyanine green angiography","volume":"75","author":"Ludolph","year":"2022","journal-title":"J. Plast. Reconstr. Aesthet. Surg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1007\/s00064-019-0622-8","article-title":"Surgical approaches to the hand","volume":"31","author":"Hohendorff","year":"2019","journal-title":"Oper. Orthop. Traumatol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1002\/art.41058","article-title":"Dipeptidylpeptidase 4 as a Marker of Activated Fibroblasts and a Potential Target for the Treatment of Fibrosis in Systemic Sclerosis","volume":"72","author":"Soare","year":"2020","journal-title":"Arthritis Rheumatol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1227","DOI":"10.1136\/annrheumdis-2020-216963","article-title":"PGC-1\u03b1 regulates autophagy to promote fibroblast activation and tissue fibrosis","volume":"79","author":"Zhang","year":"2020","journal-title":"Ann. Rheum. Dis."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Cai, A., Hardt, M., Schneider, P., Schmid, R., Lange, C., Dippold, D., Schubert, D.W., Boos, A.M., Weigand, A., and Arkudas, A. (2018). Myogenic differentiation of primary myoblasts and mesenchymal stromal cells under serum-free conditions on PCL-collagen I-nanoscaffolds. BMC Biotechnol., 18.","DOI":"10.1186\/s12896-018-0482-6"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"S\u00f6rgel, C.A., Schmid, R., Stadelmann, N., Weisbach, V., Distel, L., Horch, R.E., and Kengelbach-Weigand, A. (2022). IGF-I and Hyaluronic Acid Mitigate the Negative Effect of Irradiation on Human Skin Keratinocytes. Cancers, 14.","DOI":"10.3390\/cancers14030588"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Steiner, D., Mutschall, H., Winkler, S., Horch, R.E., and Arkudas, A. (2021). The Adipose-Derived Stem Cell and Endothelial Cell Coculture System-Role of Growth Factors?. Cells, 10.","DOI":"10.3390\/cells10082074"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"e20201916","DOI":"10.1084\/jem.20201916","article-title":"Engrailed 1 coordinates cytoskeletal reorganization to induce myofibroblast differentiation","volume":"218","author":"Matei","year":"2021","journal-title":"J. Exp. Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1627","DOI":"10.1016\/j.otsr.2019.08.016","article-title":"Segmental aponeurectomy with Z-Plasty as a treatment option in Dupuytren\u2019s disease: A retrospective cohort study","volume":"105","author":"Gardeil","year":"2019","journal-title":"Orthop. Traumatol. Surg. Res."},{"key":"ref_41","first-page":"358","article-title":"The proximal interphalangeal joint in Dupuytren\u2019s disease","volume":"10","author":"Tonkin","year":"1985","journal-title":"J. Hand Surg. Br."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1016\/0266-7681(91)90024-I","article-title":"Contracture of the proximal interphalangeal joint in Dupuytren\u2019s disease","volume":"16","author":"Andrew","year":"1991","journal-title":"J. Hand Surg. Br."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"139","DOI":"10.3233\/CH-180450","article-title":"Changes of perfusion patterns of surgical wounds under application of closed incision negative pressure wound therapy in postbariatric patients1","volume":"72","author":"Renno","year":"2019","journal-title":"Clin. Hemorheol. Microcirc."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"421","DOI":"10.3233\/CH-180544","article-title":"Indocyanine green angiography and the old question of vascular autonomy\u2014Long term changes of microcirculation in microsurgically transplanted free flaps","volume":"72","author":"Ludolph","year":"2019","journal-title":"Clin. Hemorheol. Microcirc."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"365","DOI":"10.3233\/CH-180536","article-title":"Effects of topical negative pressure therapy on perfusion and microcirculation of human skin","volume":"72","author":"Muenchow","year":"2019","journal-title":"Clin. Hemorheol. Microcirc."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1021","DOI":"10.1016\/j.jhsa.2005.05.008","article-title":"The complications of Dupuytren\u2019s contracture surgery","volume":"30","author":"Bulstrode","year":"2005","journal-title":"J. Hand Surg. Am."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1016\/S0266-7681(96)80194-X","article-title":"The \u201cS\u201d Quattro in severe Dupuytren\u2019s contracture","volume":"21","author":"Beard","year":"1996","journal-title":"J. Hand Surg."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1016\/S0363-5023(87)80291-5","article-title":"Salvage of severe recurrent Dupuytren\u2019s contracture of the ring and small fingers","volume":"12","author":"Watson","year":"1987","journal-title":"J. Hand Surg. Am."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1016\/j.hansur.2017.07.002","article-title":"Complications after treating Dupuytren\u2019s disease. A systematic literature review","volume":"36","author":"Krefter","year":"2017","journal-title":"Hand Surg. Rehabil."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1007\/s00132-019-03716-7","article-title":"Anatomy of the metacarpophalangeal and proximal interphalangeal finger joint with respect to arthroplasty","volume":"48","author":"Hohendorff","year":"2019","journal-title":"Der. Orthop."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1007\/s00132-019-03705-w","article-title":"Arthroplasty at the proximal interphalengeal joint","volume":"48","author":"Schindele","year":"2019","journal-title":"Der. Orthop."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1142\/S0218810415720077","article-title":"Simultaneous Regional Fasciectomy, Skin Grafting, and Distraction Arthrolysis of the Proximal Interphalangeal Joint for Dupuytren\u2019s Contracture of the Little Finger","volume":"20","author":"Kawakatsu","year":"2015","journal-title":"Hand Surg."}],"container-title":["Journal of Personalized Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4426\/12\/3\/378\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:30:23Z","timestamp":1760135423000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4426\/12\/3\/378"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,1]]},"references-count":52,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2022,3]]}},"alternative-id":["jpm12030378"],"URL":"https:\/\/doi.org\/10.3390\/jpm12030378","relation":{},"ISSN":["2075-4426"],"issn-type":[{"value":"2075-4426","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,1]]}}}