Staging of Dupuytren disease and indications for intervention

1. The Tubiana classification records the location and severity of Dupuytren disease ray by ray.

True

The classification established by Tubiana, Michon and Thomine records the localisation and intensity of the lesions for each ray of the hand. Tubiana's 1986 revision added a more precise assessment of the thumb and first web space and of the state of the skin, and expressed the findings as numbers suitable for recording results.

• Tubiana R. Evaluation of deformities in Dupuytren's disease. Ann Chir Main. 1986;5(1):5-11. PMID 3963905

2. Isolated Dupuytren nodules progress to a cord or contracture in almost all patients followed for several years.

False

In Reilly and colleagues' review of 59 patients first seen with isolated nodules and followed for an average of 8.7 years, 30 developed a cord and in 7 (12%) the nodule had resolved. The authors concluded that progression is common but not inevitable, and a 2026 review likewise notes that nodules do not invariably evolve into contractures with significant functional impairment.

• Reilly RM, Stern PJ, Goldfarb CA. A retrospective review of the management of Dupuytren's nodules. J Hand Surg Am. 2005;30(5):1014-8. PMID 16182060
• Degreef I, Warwick D, Lam W. Dupuytren's disease: achieving a balance between treatment, overtreatment and non-treatment. J Hand Surg Eur Vol. 2026;51(6):719-727. PMID 41673999

3. In patients referred for surgery, the severity of finger flexion contracture correlates closely with self-reported disability.

False

In 154 patients assessed before fasciectomy or dermofasciectomy, Jerosch-Herold and colleagues found only a weak correlation between flexion contracture across the four fingers and the Disabilities of the Arm, Shoulder and Hand (DASH) score (r = 0.264), and almost none for the little finger. A 2026 review similarly notes that staging systems based mainly on angular deformity correlate poorly with functional impairment.

• Jerosch-Herold C, Shepstone L, Chojnowski A, Larson D. Severity of contracture and self-reported disability in patients with Dupuytren's contracture referred for surgery. J Hand Ther. 2011;24(1):6-10; quiz 11. PMID 20952160
• Degreef I, Warwick D, Lam W. Dupuytren's disease: achieving a balance between treatment, overtreatment and non-treatment. J Hand Surg Eur Vol. 2026;51(6):719-727. PMID 41673999

4. Traditionally cited criteria for surgery are a metacarpophalangeal joint contracture greater than 30° or any proximal interphalangeal joint contracture.

True

Reilly and colleagues described these thresholds as the standard surgical criteria in their long-term review of Dupuytren nodules; after an average of 8.7 years, 5 of the 59 patients met them. A further 7 patients in that series had surgery for persistent pain on grasping without contracture, outside these criteria.

• Reilly RM, Stern PJ, Goldfarb CA. A retrospective review of the management of Dupuytren's nodules. J Hand Surg Am. 2005;30(5):1014-8. PMID 16182060

5. In a United Kingdom population-based cohort, only a minority of people newly diagnosed with Dupuytren disease at the age of 65 were estimated to undergo surgery during their lifetime.

True

Using linked primary-care and hospital records covering more than 10 million people, Broekstra and colleagues estimated the lifetime risk of surgical intervention after a diagnosis at age 65 as 23% for men and 13% for women. The authors described this risk as relatively low, and almost twice as high in men as in women.

• Broekstra DC, Kuo RYL, Burn E, Prieto-Alhambra D, Furniss D. Dupuytren Disease: Prevalence, Incidence, and Lifetime Risk of Surgical Intervention. A Population-Based Cohort Analysis. Plast Reconstr Surg. 2023;151(3):581-591. PMID 36730480