Trauma, surgery, and microtrauma as triggers for Dupuytren's disease: A systematic review

Introduction: Dupuytren's disease (DD) is a benign fibroproliferative disorder of the palmar and digital fasciae of the hand leading to progressive thickening and shortening of the pre-tendinous bands and to functionally limiting flexion contractures. The role of acute trauma, repetitive microtrauma or elective hand surgery (like trigger finger release or open carpal tunnel release) as triggering factors in predisposed individuals has lately been affirmed by scientific evidence. The aim of this systematic review is to evaluate the incidence of Dupuytren's disease in adults following acute trauma, chronic microtrauma, or elective hand surgery.

Methods: A systematic review was conducted in accordance with the PRISMA 2020 guidelines and was prospectively registered with PROSPERO (CRD420251110336). An extensive search of four databases was performed to identify studies evaluating new-onset Dupuytren's disease following elective hand surgery, acute trauma, or chronic microtrauma. The Joanna Briggs Institute tool was used to assess the risk of bias, and overall certainty of evidence was appraised using GRADE.

Results: Of 822 records identified, 25 studies were included. Due to substantial heterogeneity, meta-analysis was not possible and results were reported descriptively. Acute surgical trauma showed postoperative incidence ranging from 0.80% to 11.5%, while chronic microtrauma was the most frequently studied exposure, with prevalence ranging from 1.9% to 26.6%. The certainty of the evidence was mostly low to very low according to GRADE.

Conclusions: Despite a limited overall certainty, current evidence suggests a possible association between acute trauma, elective hand surgery, and chronic microtrauma with earlier onset or accelerated progression of DD. The interaction of multiple risk factors in biologically predisposed individuals seems to lead to DD, with mechanical insults that may contribute as initiating or enhancing "second hits" rather than isolated causative factors. Regarding elective surgery and acute trauma, it remains unclear whether they primarily act as initiating events or rather accelerate a pre-existing but subclinical disease process.