The following case study is of an 83 year old male with severe Dupuytren’s Contracture of the PIP and MCP joints of the long and ring fingers of his left hand. He had no prior surgery. He sought surgical treatment because he was no longer able to hold a golf club. Dr. Agee decided to use Digit Widgets on both fingers prior to fasciectomy to facilitate access into the palm and fingers. In his initial surgery, the Digit Widgets were applied and the bands in the palm were cut, but not excised.

The patient tolerated the devices very well. He had no pin tract problems, pain, or swelling. He wore the heavy elastic bands 24/7. After five weeks, he had gained 35º on both fingers. He was then scheduled for a subtotal palmar fasciectomy. No skin grafts were used although there was considerable skin shortage after surgery. The elastic bands were re-applied during the first post-op week.

Over the next three weeks, he gained another 20º on the long finger and 38º on the ring. His ROM graph showed a continued gain in motion, but the patient requested the devices be removed. The Digit Widgets were removed after 8 weeks total wearing time. He was referred to Hand Therapy for splinting and plaster casting as needed. He was seen six times in therapy.

One month following device removal, the patient demonstrates excellent functional flexion and extension. Overall, he gained 60º extension on the PIP of the long finger and 74º on the PIP of the ring finger.

1. JM, 83 y.o. No prior surgery on Left hand. Pre Digit Widgets. Flexion contractures from Dupuytren’s Disease, long and ring fingers.

AROM:
PIP long finger: 88/125 (ext/flex)
PIP ring finger: 108/125 (ext/flex)
MCP long finger: 77/105
MCP ring finger: 71/108

Surgery performed: Application of two Digit Widgets, release of palmar bands without excision.

2. JM, 8/21/02. Post Digit Widget application. Initiation of extensor torque at time of surgery. Light weight bands applied, patient instructed to wear torque 23/24 hrs per day.

3. JM, 8/21/02. Lateral view, Post Digit Widget application.

4. JM, 9/26/02. Having worn the Digit Widgets for five weeks, PIP extension is now adequate to allow Dupuytren’s Contracture release of MCP and PIP joints with subtotal palmar fasciectomy.

Pre-release ROM:
PIP long finger: 53/100
PIP ring finger: 73/105

Interim ROM (no photo) JM 10/15/02
PIP long finger: 45/98
PIP ring finger: 53/103

5. JM, 10/24/02. Digit Widget devices have been worn for 8 weeks. Three weeks post surgical release. ROM still improving, but patient wishes devices removed.

AROM at time of Digit Widget removal:
PIP long finger: 33/72*
PIP ring finger: 35/74*

* Flexion measured against the resistance of the heaviest elastic band. Prior flexion measurements were taken with the bands removed.

6. JM, 10/24/02. Active flexion with Digit Widgets in place. Note that bone pin placement does not restrict extensor tendon excursion and the patient has excellent DIP motion.

7. JM, 11/26/02. Four weeks post Digit Widget removal. Maximum active extension. He has had 6 hand therapy visits for progressive splinting, serial plaster casting and ROM exercises. He still has significant MCP joint flexion contractures.

AROM:
MCP long finger: 66/95
MCP ring finger: 65/95
PIP long finger: 28/90
PIP ring finger: 34/92

8. JM, 11/26/02. Four weeks post Digit Widget removal. Maximum active extension.

9. JM, 11/26/02. Maximum active flexion.

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