Mateusz Gładysz FESSH prep

FESSH prep Dupuytren disease prognosis recurrence

Dupuytren's diathesis

Last reviewed v1.0

FESSH-002Dupuytren disease●●○ intermediate

Regarding the revised Dupuytren's diathesis (Hindocha et al., 2006), which describes prognostic indicators for risk of disease recurrence after surgical management:

  1. 1.Bilateral disease is a recognised diathesis criterion.

  2. 2.The presence of Garrod's (knuckle) pads is a recognised diathesis criterion.

  3. 3.A positive family history (one or more affected first-degree relatives) is a diathesis criterion.

  4. 4.Age at onset younger than 50 years is a diathesis criterion.

  5. 5.Radial-side hand involvement is one of the five revised Hindocha (2006) diathesis criteria.

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Question ID
FESSH-002
First published
Last reviewed
Version
v1.0
Answer key and explanations — open after answering

  1. 1. Bilateral disease is a recognised diathesis criterion.

    True

    Bilateral palmar disease is a diathesis criterion in both the original Hueston framework and the revised Hindocha framework. Recurrence was observed in 47% of patients with bilateral disease in the Hindocha cohort, and the criterion was retained in the multivariate model predicting recurrence.

    • Hindocha S, Stanley JK, Watson S, Bayat A. Dupuytren's diathesis revisited: Evaluation of prognostic indicators for risk of disease recurrence. J Hand Surg Am. 2006;31(10):1626-1634. PMID 17145383

  2. 2. The presence of Garrod's (knuckle) pads is a recognised diathesis criterion.

    True

    In the Hindocha 2006 cohort, recurrence was observed in 63% of patients with Garrod's pads — the highest individual recurrence rate among the factors analysed. The revised diathesis specifically restricts the ectopic-lesions criterion to Garrod's pads alone, having found that Peyronie's disease and plantar fibromatosis did not retain independent predictive value in the multivariate model.

    • Hindocha S, Stanley JK, Watson S, Bayat A. Dupuytren's diathesis revisited: Evaluation of prognostic indicators for risk of disease recurrence. J Hand Surg Am. 2006;31(10):1626-1634. PMID 17145383

  3. 3. A positive family history (one or more affected first-degree relatives) is a diathesis criterion.

    True

    Family history is a Hueston original criterion that was retained, and refined, by Hindocha et al. (2006) to require at least one affected first-degree relative — sibling or parent. Recurrence was observed in 48% of patients with positive family history in the Hindocha cohort.

    • Hindocha S, Stanley JK, Watson S, Bayat A. Dupuytren's diathesis revisited: Evaluation of prognostic indicators for risk of disease recurrence. J Hand Surg Am. 2006;31(10):1626-1634. PMID 17145383

  4. 4. Age at onset younger than 50 years is a diathesis criterion.

    True

    Age at onset younger than 50 years was newly added by Hindocha et al. (2006) to the original four-criterion Hueston framework. Recurrence was observed in 47% of patients with onset before 50. The presence of all five revised diathesis factors increases recurrence risk to 71%, compared with a baseline of 23% in patients with no diathesis factors.

    • Hindocha S, Stanley JK, Watson S, Bayat A. Dupuytren's diathesis revisited: Evaluation of prognostic indicators for risk of disease recurrence. J Hand Surg Am. 2006;31(10):1626-1634. PMID 17145383

  5. 5. Radial-side hand involvement is one of the five revised Hindocha (2006) diathesis criteria.

    False

    Radial-side hand involvement (thumb, index, long finger, or thenar eminence) has been associated with disease recurrence and ectopic involvement in the Japanese cohort reported by Abe et al. (2004), but it is not one of the five revised Hindocha diathesis criteria. The Hindocha set comprises male sex, age at onset younger than 50 years, bilateral disease, family history in a first-degree relative, and Garrod's pads.

    • Hindocha S, Stanley JK, Watson S, Bayat A. Dupuytren's diathesis revisited: Evaluation of prognostic indicators for risk of disease recurrence. J Hand Surg Am. 2006;31(10):1626-1634. PMID 17145383
    • Abe Y, Rokkaku T, Ofuchi S, Tokunaga S, Takahashi K, Moriya H. An objective method to evaluate the risk of recurrence and extension of Dupuytren's disease. J Hand Surg Br. 2004;29(5):427-430. PMID 15336743