Delayed Manipulation After Collagenase Injection for Dupuytren’s Contracture
Location
LSU Health NO Center for Advanced Learning and Simulation (CALS)
Document Type
Event
Start Date
20-6-2026 10:20 AM
End Date
20-6-2026 11:20 AM
Publication Date
June 2026
Description
Introduction: Collagenase Clostridium histolyticum (CCH) injection followed by manual manipulation within 24-72 hours is a well-established, minimally invasive treatment for Dupuytren’s contracture. However, in clinical practice, manipulation may be delayed due to patient-related or system-related factors, and outcomes beyond the standard window are poorly described. This study describes two cases of delayed manipulation following CCH injection to evaluate the feasibility, outcomes, and complications associated with extended manipulation intervals.
Methods: Two patients with Dupuytren’s contracture treated with CCH injection followed by delayed manipulation were retrospectively reviewed. Manipulation occurred at 14 and 21 days after injection. Clinical outcomes were assessed through review of medical records and included degree of contracture correction on physical examination, patient-reported functional improvement, and peri-procedural complications.
Results: Both patients achieved satisfactory correction of Dupuytren’s contracture despite delayed manipulation beyond the conventional 24-72-hour window following CCH injection. Both procedures resulted in small palmar skin tears that were managed conservatively with local wound care. Neither patient experienced neurovascular compromise, tendon rupture, or early recurrence.
Discussion: These cases suggest that enzymatic weakening of the Dupuytren’s cord following CCH injection may persist beyond the traditional 24-72- hour manipulation window, permitting effective contracture release despite delayed manipulation. Skin tears occurred in both patients, consistent with known complications of CCH manipulation and previously reported rates of increased skin tearing in studies evaluating delayed manipulation within the first week after injection. Delayed manipulation may increase susceptibility to skin compromise due to prolong tissue weakening or the need for greater mechanical force to rupture the cord. Despite this complication, both patients experienced meaningful functional improvement. Although limited by small sample size, these findings contribute to the limited literature describing outcomes following delayed manipulation.
Significance/Clinical relevance: Delayed manipulation after CCH injection may still achieve effective contracture correction when timely follow-up is not feasible, though clinicians should anticipate the possibility of skin tears.
Recommended Citation
Juneau, Annelise, "Delayed Manipulation After Collagenase Injection for Dupuytren’s Contracture" (2026). Dept. of Orthopaedics: Robert D. D’Ambrosia Lectureship & Research Day. 6.
https://digitalscholar.lsuhsc.edu/ortho_rd/2026/student/6
Delayed Manipulation After Collagenase Injection for Dupuytren’s Contracture
LSU Health NO Center for Advanced Learning and Simulation (CALS)
Introduction: Collagenase Clostridium histolyticum (CCH) injection followed by manual manipulation within 24-72 hours is a well-established, minimally invasive treatment for Dupuytren’s contracture. However, in clinical practice, manipulation may be delayed due to patient-related or system-related factors, and outcomes beyond the standard window are poorly described. This study describes two cases of delayed manipulation following CCH injection to evaluate the feasibility, outcomes, and complications associated with extended manipulation intervals.
Methods: Two patients with Dupuytren’s contracture treated with CCH injection followed by delayed manipulation were retrospectively reviewed. Manipulation occurred at 14 and 21 days after injection. Clinical outcomes were assessed through review of medical records and included degree of contracture correction on physical examination, patient-reported functional improvement, and peri-procedural complications.
Results: Both patients achieved satisfactory correction of Dupuytren’s contracture despite delayed manipulation beyond the conventional 24-72-hour window following CCH injection. Both procedures resulted in small palmar skin tears that were managed conservatively with local wound care. Neither patient experienced neurovascular compromise, tendon rupture, or early recurrence.
Discussion: These cases suggest that enzymatic weakening of the Dupuytren’s cord following CCH injection may persist beyond the traditional 24-72- hour manipulation window, permitting effective contracture release despite delayed manipulation. Skin tears occurred in both patients, consistent with known complications of CCH manipulation and previously reported rates of increased skin tearing in studies evaluating delayed manipulation within the first week after injection. Delayed manipulation may increase susceptibility to skin compromise due to prolong tissue weakening or the need for greater mechanical force to rupture the cord. Despite this complication, both patients experienced meaningful functional improvement. Although limited by small sample size, these findings contribute to the limited literature describing outcomes following delayed manipulation.
Significance/Clinical relevance: Delayed manipulation after CCH injection may still achieve effective contracture correction when timely follow-up is not feasible, though clinicians should anticipate the possibility of skin tears.