The isolated digital cord in Dupuytren's contracture: anatomy and clinical significance.

This article describes the isolated occurrence of Dupuytren's pathologic fascial cords within digits of the hand. Thirty-seven cords were found in 32 patients with nearly half (45.6%) occurring in digits other than the small finger. Almost all patients (97.3%) had other clinical evidence of Dupuytren's disease. Cords were either single (83.8%) or double (16.2%) and originated from the periosteum at the base of the proximal phalanx in conjunction with adjacent ligaments and intrinsic tendons. They proceeded in an oblique direction to displace and then cross the neurovascular bundles before inserting on the bone and/or flexor tendon sheath of the middle phalanx. The average loss of extension of the proximal interphalangeal joint that resulted from these cords was 46 degrees, and surgical excision of the involved cords resulted in an average improvement of 24 degrees (53%).