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Classification System

     

HOW IS IT STAGED OR GRADED?

Dupuytren's Contracture is classified in a variety of ways based on disease presentation and progression.

The disease process includes two structures, the nodule and the cord, which are quite different microscopically and biochemically, and early ("proliferative") nodules are biologically different from mature ("involutional") nodules.

Dupuytren's nodules represent the early, active form of fibrosis, and are the hard lumps in the palm. Cords develop later; they feel like strings beneath the skin and are responsible for the tethering which results in contractures.

Contractures often span several adjacent joints. For affected joints, if bending one joint allows the adjacent joint to be fully straightened and vice versa, the contracture is referred to as a "composite contracture". If an affected joint can not be fully straightened in any hand position, the result is called a "fixed contracture"
   

Tubiana's classification

This classification system is simple and helpful. It grades the contracture into one of four stages based on the combined angles of contracture of the MCP and PIP joints, and may be applied to both composite and fixed contractures: This angle is illustrated by the blue lines in this diagram:
 
 
© The Hand Center, Charles Eaton

 

Last updated 10.2.08

   

 

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