LAUSR

A 67-year-old right-hand-dominant man presented with Tubiana Stage 2 Dupuytren's Disease of his left, non-dominant, little finger (30° MCPJ and 20° PIPJ flexion contractures). After thorough discussion he elected to proceed with Xiapex® collagenase. At the six month follow-up he had had an early severe recurrence of his to Tubiana Stage 3 (35° MCPJ and 60° PIPJ flexion contractures). Due to the increased deformity the decision was made to proceed to a dermo-fasciectomy. The dermo-fasciectomy was performed as per Heuston from mid lateral to mid lateral on the little finger P1. On excision of the P1 skin and Dupuytren's cord it was noted that there was area of hardened tissue at the volar PIPJ. Intra-operative imaging was undertaken showing osteoarthritis of the DIPJ and PIPJ and an calcific ossific nidus in keeping with the clinical findings. Full excision was achieved and the operation completed as shown with an excellent correction. Histopathology was not undertaken given the intra-operative findings and imaging. The CORDLESS study sites a five year recurrence rate following Xiapex injection of 47%. In comparison recurrence rates in dermo-fasciectomy have been reported from 8 to 13.6%. If a primary dermo-fasciectomy or simple fasciectomy had been performed then it is unlikely that this variant would have been observed as the cord would have been excised. Calcification ossification within resected tissue specimens is rare. Following a review of the literature we believe we are reporting the third case of calcified ossified Dupuytren's contracture, and the first case following Xiapex® injection. Xiapex® injections are becoming increasingly used as a primary management for Dupuytren's contractures. Patients report high satisfaction rates, however fewer patients have tendency towards collagenase injections for recurrent disease. Given the increased incidence of the use of collagenase we felt this case warranted reporting as calcification ossification was noted upon revision surgery. We conclude that the noted calcification ossification is not related to the Xiapex injection, and is probably coincidental. This is the first case of ossification in a Dupuytren's treated with Xiapex® however this is probably coincidental. Calcified Ossified Dupuytren's is a very rare but recognised subtype of Dupuytren's contracture. The presence of calcification ossification does not alter management, however a fasciectomy or dermo-fasciectomy may have been a better initial treatment option in this case.