Collagenase Versus Operative Management for Dupuytren Contracture: A Propensity-matched Cohort of 16,888 Patients.

BACKGROUND: Dupuytren contracture (DC) is a fibroproliferative disorder of the palmar fascia, commonly managed through enzymatic collagenase injections or surgical interventions such as fasciotomy or fasciectomy. This study aims to compare clinical outcomes and complication rates between patients undergoing collagenase injection and those receiving surgical treatment for DC. METHODS: Using the TriNetX US Collaborative Network, a retrospective cohort study was conducted including 8444 patients who underwent collagenase injection and 8444 propensity score-matched patients who received surgical management for DC. Key outcomes assessed included postoperative infection, hematoma, nerve injury, reintervention rates, functional outcomes (occupational therapy utilization), and emergency room visits. Risk differences, risk ratios, and odds ratios (OR) were calculated using risk analysis. Follow-up was 180 days. RESULTS: Collagenase treatment was associated with significantly lower risks of postoperative infection (0.7% versus 1.4%, OR 0.49, P < 0.001) compared to surgery. Nonetheless, collagenase was associated with a significantly higher reintervention rate (31.7% versus 16.2%, OR 2.40, P < 0.001). No significant differences were observed in iatrogenic nerve injuries (0.2% in both groups), hematoma (0.3% in both groups), functional outcomes (35.9% versus 36.7%, P = 0.284), or emergency room utilization (24.6% versus 24.5%, P = 0.915). CONCLUSIONS: Collagenase injection for DC is associated with fewer short-term complications but nearly doubles the risk of reintervention compared to surgical management.