<prompt> A 65-year-old alcoholic suffering from diabetes has a flexion deformity of the right little linger over the metacarpophalangeal joint of around 15 degrees. The ideal management would be:ObservationPercutaneous fasciotomyPartial selective fasciectomyComplete fasciectomy  <response>: Ans. a. Observation Ref: Campbell s Orthopaedics Ue p4273A 65-year-old alcoholic suffering from diabetes has a flexion deformity of the right little finger over the metacarpophalangeal joint of around 15 degrees. Diagnosis of this patient is Dupuytren s contracture. The ideal management would be observation.Dupuytrens contracture: In the absence of contractures, treatment usually is not indicated because nodules and cords usually are painless. Proximal interphalangeal joint and metacarpophalangeal joint contractures of 15a and 3 P or more, respectively, usually are disabling and may warrant surgical intervention. Campbells Orthopaedics 11e p4273Surgery is indicated in Dupuytren contracture when the deformity is disabling, when deformity at MCP joint is 30 or PIP joint 15. Dupuytrens Contracture Dupuytrens contracture is nodular hypertrophy and contracture of superficial palmar fascia palmar aponeurosis. More common in males, age 40-60 years0 Bilateral in 45 cases but involvement is asymmetricalAssociations: Higher incidence in epileptics receiving phenytoin therapy, diabetics, alcoholic cirrhosis, AIDS, pulmonary tuberculosisClinical Features: A middle aged man usually complains of nodular thickening of palm Flexion contracture most commonly occur at metacarpophalangeal joint PIP joint DIP joint0 MC finger involved: Ring finger0 Little finger Thumb and index finger PIP contractures soon becomes irreversibleTreatment: In the absence of contractures, treatment usually is not indicated because nodules and cords are painless0. Patients with slowly progressive, non-disabling contractures should be examined periodically, perhaps every 3 months0, Primary indication for surgery is fixed contracture of 3Pat MP joint or 15 at PIP joint. Surgery does not cure the disease, it only partially corrects the deformity and recurrences are common. The goal of surgical release is to achieve regional fasciectomy that will allow maximal untethered joint motion.Complete fasciectomy is unnecessary0.Surgical Procedures used in Dupuytrens Contracture Subcutaneous fasciectomy Partial selective fasciectomy Complete fasciectomy Fasciectomy with skin grafting Amputation Resection and arthrodesis of PIP 