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Dupuytren's fasciectomy

Surgeon-side topic for dupuytren's fasciectomy. Backed by 317 articles from the corpus, retrieved via combined MeSH + title-text matching.

38 citationsUpdated Aug 2026

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Overview

Surgery remains the gold-standard treatment for progressive Dupuytren contractures [2]. Limited palmar fasciectomy is the most common surgical option for Dupuytren disease [2] and was the most common surgical procedure for Dupuytren's contracture in England between 2003 and 2008 [3]. During this period, there was a marked shift from inpatient to day-case fasciectomy procedures in England [3]. Dermofasciectomy is a highly effective surgical intervention for advanced Dupuytren disease, offering substantial long-term benefits in function and disease control [4].

Limited fasciectomy is currently the most reliable long-term treatment for Dupuytren's contracture, but carries a significant risk for complications [8]. Long-term overall reintervention and perceived recurrence rates are higher with collagenase Clostridium histolyticum (CCH) treatment than with surgical fasciectomy for single-digit Dupuytren contracture [7]. Percutaneous needle fasciotomy is safe and reliable in patients with advanced Dupuytren disease, resulting in predictably acceptable outcomes with a low risk of complications [13]. Percutaneous fasciotomy is considered a useful and safe technique in the surgical armamentarium for Dupuytren disease [1].

Patients with Dupuytren's contracture gain significant functional benefit following surgical correction of the deformity [10]. Hand normality improves after surgical treatment for Dupuytren disease [5]. Hand normality scores perform favorably compared with preexisting outcome measures, suggesting they may be a useful adjunct to gauge surgical success [5]. Little agreement exists on treatment recommendations for common presentations of Dupuytren disease among international hand surgeons [12]. Advancements in surgical and therapy management for Dupuytren's disease include reviews of indications, surgical options, non-surgical techniques, and therapy interventions to link patient-specific problems to appropriate treatments [11]. Patients undergoing surgical release of trigger finger have significantly higher odds and an expedited rate of developing new-onset Dupuytren disease compared with those managed by other interventions [6]. Patients undergoing surgical release of trigger finger have significantly higher odds of undergoing subsequent treatment by fasciectomy compared with those managed by other interventions [6].

Anatomy & Pathophysiology

Hand trauma, particularly surgical trauma and repetitive mechanical stress, is associated with the onset of Dupuytren's disease [44]. The condition impacts the extensor mechanism, contributing to hand deformities [43].

The proposed method for measuring Dupuytren’s contractures assesses the role of dynamism on contracture by measuring PIPJ PED with the MCPJ in both passive flexion and extension, which may affect surgical planning [50].

Classification

There is a lack of standardization in the recording of data for Dupuytren's disease, leading to major inconsistencies in reporting that make critical comparison of techniques or results impossible [23]. Various methods have been used to classify Dupuytren's disease, including assessment of aspects such as degree of contracture and type of disease [23]. Scoring systems have been developed to quantify Dupuytren's disease by producing a series of numbers or discrete variables [23].

Tubiana: Used to grade patients with Dupuytren's disease [54].

Clinical Presentation

Dupuytren's disease is prevalent in the general population, with a majority of diagnosed individuals undergoing treatment [37]. The primary motivation for patients to seek intervention is the possibility of regaining hand function [33]. Patients with Dupuytren's contracture gain significant functional benefit following surgical improvement or correction of the deformity [10]. Hand normality improves after surgery for Dupuytren disease, performing favorably compared with preexisting outcome measures [5].

Total active finger extension improves enough for patients to reach a functional range of motion despite impairment of active finger flexion remaining 12 months after treatment [27]. Collagenase injection and surgical fasciectomy improve finger joint contracture over pretreatment status, but there is a high prevalence of joint contracture in treated fingers 5 years after treatment [16]. Recurrent Dupuytren's disease after fasciectomy and collagenase Clostridium histolyticum are histologically indistinguishable [14].

Patients solely undergoing surgical release of their trigger finger had significantly higher odds and an expedited rate of developing new-onset Dupuytren disease overall and undergoing subsequent treatment by fasciectomy compared with trigger fingers managed by other interventions [6]. Use of a Budapest criteria checklist may guide documentation and speed recognition for an earlier diagnosis of Complex Regional Pain Syndrome (CRPS) in patients with Dupuytren's and an atypical post-fasciectomy response [18].

There is limited evidence to guide the management of patients with Dupuytren's contracture [9]. There is no recommended standard set of outcomes to report Dupuytren's disease outcomes studies, nor are there guidelines on how the outcomes themselves should be reported [33]. There are inconsistencies in reporting of functional outcomes, such as range of motion and disease recurrence, in Dupuytren's disease research [33].

Investigations

There is currently limited evidence to guide the management of patients with Dupuytren's contracture [9]. A lack of standardization in recording data for Dupuytren's disease makes critical comparison of techniques or results impossible due to major inconsistencies in reporting [23].

Other Considerations: Dupuytren disease should be included in the differential diagnosis of a nodule in the palm or fingers or contracture of the fingers of children [58]. Hand normality improves after surgery for Dupuytren disease and performs favorably compared with preexisting outcome measures [5].

Surgical Options: Limited fasciectomy: This is the most common surgical option for progressive Dupuytren contractures [2]. It is currently the most reliable long-term treatment for Dupuytren's contracture, though the risk for complications is significant [8]. Dermofasciectomy: This offers substantial long-term benefits in terms of function and disease control for advanced Dupuytren disease [4]. Staged procedure: A simple staged procedure using a central slip facilitation device is a valid alternative for managing severe Dupuytren's proximal interphalangeal joint (PIPJ) contracture, demonstrating reliable correction and acceptable patient outcomes [15]. Salvage procedure: Proximal interphalangeal joint arthrodesis combined with needle fasciotomy or segmental fasciectomy provides a satisfactory salvage procedure for severe recurrent Dupuytren's disease [30].

Histology: Recurrent Dupuytren's disease after fasciectomy is histologically indistinguishable from recurrence after collagenase Clostridium histolyticum injection [14].

Perioperative Management: Perioperative corticosteroid administration is safe and improves early range of motion and DASH scores following Dupuytren's fasciectomy [22].

Treatment

Non-Operative

Pre-operative therapeutic interventions for Dupuytren's disease yield largely positive outcomes [19]. Needle aponeurotomy is a minimally invasive technique performed under local anesthesia that does not typically require formal postoperative hand therapy [49]. Percutaneous needle fasciotomy is a useful and safe technique in the surgical armamentarium for Dupuytren disease [1]. Needle fasciotomy and collagenase injection have similar outcomes at 3 months and 1 year in Dupuytren's disease with predominantly metacarpophalangeal joint involvement [24].

Operative

Indications: Surgical intervention is usually considered when metacarpophalangeal joint contracture is ≥30° or when there is any degree of proximal interphalangeal joint contracture [49]. The longer a Dupuytren deformity is allowed to progress, the greater the chance of the contracture becoming irreversible, particularly for proximal interphalangeal joint contractures [49]. There is low-level evidence that both surgical and nonsurgical treatments provide clinically important improvements for recurrent Dupuytren contracture [20].

Surgical Approach / Technique: Historically, partial, regional, or limited fasciectomy has been the most widely used surgical procedure among hand surgeons because it is associated with a lower rate of recurrence than fasciotomy [49]. The modified McCash technique is a reliable method for managing Dupuytren disease, offering contracture release with minimal dissection, decreased postoperative pain, and reduced risk of contracture and hematoma formation [45]. A simple staged procedure using a central slip facilitation device is a valid alternative for managing severe Dupuytren's proximal interphalangeal joint contracture, demonstrating reliable correction and acceptable outcomes [15].

Setting of Care: Fasciectomy performed under local anaesthetic with adrenaline, without an arm tourniquet, and in a community setting is safe and results in favourable outcomes regarding contracture correction, functional scores, and short-term complications [57].

Other Considerations: Hand normality improves after surgery for Dupuytren disease [5]. Long-term overall reintervention and perceived recurrence following treatment of single-digit Dupuytren contracture are higher with collagenase clostridium histolyticum (CCH) than with surgical fasciectomy [7]. Surgical release of trigger finger is associated with significantly higher odds and an expedited rate of developing new-onset Dupuytren disease and undergoing subsequent fasciectomy compared to other trigger finger interventions [6]. There is little agreement on treatment recommendations for common presentations of Dupuytren disease among international hand surgeons [12].

Complications

Limited Fasciectomy: Limited fasciectomy carries a significant risk for complications [8].

New-Onset Dupuytren Disease: Surgical release of trigger finger is associated with a significantly higher odds and expedited rate of developing new-onset Dupuytren disease in the short-term postoperative period compared to other interventions [6]. Patients who develop new-onset Dupuytren disease after trigger finger release have a higher likelihood of undergoing subsequent treatment by fasciectomy [6].

Joint Contracture: Collagenase injection and surgical fasciectomy both resulted in a high prevalence of finger joint contracture in treated fingers 5 years after treatment [16].

Recurrence: Recurrence after Dupuytren contracture treatment is common, with a mean follow-up of 3.8 years in prospectively collected cohorts [61]. Approximately 10% of patients treated with collagenase injections for Dupuytren contracture underwent surgery within 5 years [62].

Recovery

Light activity (weeks): Limited fasciectomy remains the most common surgical option for progressive Dupuytren contractures [2]. Long-term overall reintervention and perceived recurrence following treatment of single-digit Dupuytren contracture are higher with collagenase Clostridium histolyticum (CCH) treatment than with surgical fasciectomy [7].

Full activity (months): The little finger in Dupuytren's disease requires special attention during surgery and rehabilitation [32].

Complete recovery / outcome plateau (months): There is low level of evidence that both surgical and nonsurgical treatments provide clinically important improvements for recurrent Dupuytren contracture [20].

Rehabilitation protocol: A postoperative protocol using a splint and hand therapy was no better than hand therapy alone in minimizing postoperative flexion contractures after operative release of a Dupuytren's contracture [40].

Functional milestones: Outcomes from therapeutic interventions for pre-operative management of Dupuytren's disease were largely positive [19].

Key Evidence

  • [L4] The authors believe this refinement of the earlier method of percutaneous fasciotomy is a useful and safe technique in the surgical armamentarium for the treatment of Dupuytren disease. [1] (10.1016/j.jhsa.2013.08.087)
  • [L4] Surgery remains the gold-standard treatment for progressive Dupuytren contractures, with limited palmar fasciectomy being the most common option. [2] (10.1016/j.jhsa.2011.03.002)
  • [L4] Between 2003 and 2008, fasciectomy was the most common surgical procedure for Dupuytren's contracture in England, with a marked shift from inpatient to day-case procedures likely due to economic trends and healthcare system changes. [3] (10.1186/1471-2474-12-73)
  • [L3] Dermofasciectomy appears to be a highly effective surgical intervention for advanced Dupuytren disease, offering substantial long-term benefits in terms of function and disease control. [4] (10.1016/j.jhsa.2025.02.007)
  • [L3] Hand normality improved after surgery for Dupuytren disease, and this score performed favorably compared with preexisting outcome measures, which suggests it may be a useful adjunct to gauge the success of surgery. [5] (10.1016/j.jhsa.2021.01.022)
  • [L3] Patients solely undergoing surgical release of their trigger finger had significantly higher odds and expedited rate of developing new-onset Dupuytren disease overall and undergoing subsequent treatment by fasciectomy compared with trigger fingers managed by other interventions. [6] (10.1177/15589447221077375)
  • [L4] Long-term overall reintervention and perceived recurrence following treatment of Dupuytren contracture affecting a single digit were higher with CCH treatment than surgical fasciectomy when comparing groups with similar baseline characteristics. [7] (10.1016/j.jhsa.2021.05.022)
  • [L5] In the long term, limited fasciectomy is currently the most reliable treatment for Dupuytren's contracture, but the risk for complications is significant. [8] (10.1530/eor-23-0033)
  • [L2] Currently there remains limited evidence to guide the management of patients with Dupuytren's contracture. [9] (10.1302/0301-620x.100b9.bjj-2017-1194.r2)
  • [L3] Patients with Dupuytren's contracture of the hand gain a significant functional benefit following surgical improvement or correction of the deformity. [10] (10.1054/jhsb.2002.0776)
  • [L5] The article highlights advancements in surgical and therapy management for Dupuytren's disease, reviewing indications, surgical options, non-surgical techniques, and therapy interventions to assist in linking patient-specific problems to appropriate treatment choices. [11] (10.1016/j.jht.2013.10.006)
  • [L4] Little agreement exists on treatment recommendations for common presentations of Dupuytren disease in this sample of international hand surgeons. [12] (10.1016/j.jhsa.2017.08.023)
  • [L4] Percutaneous needle fasciotomy is safe and reliable even in patients with advanced Dupuytren disease, resulting in predictably acceptable outcome with low risk of complications. [13] (10.1186/s13018-024-04844-3)
  • [L3] Recurrent Dupuytren's disease after fasciectomy and collagenase Clostridium histolyticum are histologically indistinguishable. [14] (10.1177/1753193419900483)
  • [L4] The simple staged procedure is a valid alternative in the management of severe Dupuytren's PIPJ contracture, demonstrating reliable, reproducible correction of the deformity and acceptable patient outcomes. [15] (10.1177/1753193412439673)
  • [L3] In patients with Dupuytren disease, collagenase injection and surgical fasciectomy improved finger joint contracture over the pretreatment status but had a high prevalence of joint contracture in the treated fingers 5 years after treatment. [16] (10.1016/j.jhsa.2022.04.019)
  • [L4] Use of a Budapest criteria checklist may guide documentation and speed recognition for an earlier diagnosis of CRPS in patients with Dupuytren's and an atypical post-fasciectomy response. [18] (10.1016/j.jht.2024.09.002)
  • [L1] Outcomes from therapeutic interventions for pre-operative management of Dupuytren's Disease were largely positive. [19] (10.1177/17589983241227162)
  • [L1] There is low level of evidence that both surgical and nonsurgical treatments provide clinically important improvements for recurrent Dupuytren contracture. [20] (10.1177/1558944721994220)
  • [L3] Perioperative corticosteroid administration appears to be safe and improves early range of motion and DASH scores following Dupuytren's fasciectomy. [22] (10.1177/15589447221084013)
  • [L4] [23] (10.1177/1753193414560511)
  • [L2] At 3 months and 1 year, the outcomes of needle fasciotomy and collagenase injection are the same in Dupuytren's disease with predominantly metacarpophalangeal joint involvement. [24] (10.1177/1753193415617385)
  • [L4] The total active finger extension improved enough for the patients to reach a functional range of motion despite an impairment of active finger flexion still present 12 months after treatment. [27] (10.1016/j.jhsa.2014.04.029)
  • [L4] Proximal interphalangeal joint arthrodesis combined with needle fasciotomy or segmental fasciectomy provides a satisfactory salvage procedure in cases of severe recurrent Dupuytren's disease. [30] (10.1177/1753193420960309)
  • [L4] The LF in Dupuytren's disease requires special attention during surgery and rehabilitation. [32] (10.1186/s13018-025-06176-2)
  • [L1] [33] (10.1177/1753193420903624)
  • [L3] Clinically important Dupuytren's disease is common in the general population, with a majority of diagnosed individuals undergoing treatment. [37] (10.1177/1753193416687914)
  • [L2] After operative release of a Dupuytren's contracture, a postoperative protocol using a splint and hand therapy was no better than hand therapy alone in minimizing postoperative flexion contractures. [40] (10.1177/1753193412437631)
  • [L5] By recognizing the impact of Dupuytren's disease on the extensor mechanism, hand surgeons and hand therapists alike can improve their understanding of the underlying mechanisms and better manage associated deformities. [43] (10.1016/j.jht.2024.12.017)
  • [L1] Hand trauma, particularly surgical trauma and repetitive mechanical stress, is associated with the onset of Dupuytren's disease. [44] (10.1177/17531934251360545)
  • [L4] The modified McCash technique is a reliable and important technique for managing Dupuytren disease, offering contracture release with minimal dissection, decreased postoperative pain, and reduced risk of contracture and hematoma formation. [45] (10.1016/j.jhsa.2017.01.018)
  • [L4] [49] (10.1007/s11552-014-9645-7)
  • [L5] The proposed method measures PIPJ PED with the MCPJ in both passive flexion and extension to assess the role of dynamism on contracture, which may affect surgical planning. [50] (10.1177/17531934251318896)
  • [L1] [54] (10.1177/17531934251315572)
  • [L4] This study suggests that a fasciectomy performed under local anaesthetic with adrenaline and without an arm tourniquet and in a community setting is safe, and results in favourable outcomes regarding the degree of correction of contracture achieved, functional scores, and short-term complications. [57] (10.1302/0301-620x.102b10.bjj-2019-1685.r2)
  • [L4] Dupuytren disease should be included in the differential diagnosis of a nodule in the palm or fingers or contracture of the fingers of children. [58] (10.1016/j.jhsa.2016.08.011)
  • [L2] In prospectively collected cohorts with a mean 3.8 years of follow-up, recurrence after Dupuytren contracture treatment was common. [61] (10.1016/j.jhsg.2026.100979)
  • [L3] Approximately 10% of patients treated with collagenase injections for Dupuytren contracture underwent surgery within 5 years. [62] (10.1016/j.jhsg.2025.100768)

See Also

References

[1] Open Fasciotomy: Still a Major Weapon in the Surgical Armamentarium Against Dupuytren Disease?. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2013.08.087

[2] The Treatment of Dupuytren Disease. The Journal of Hand Surgery. 2011. DOI: 10.1016/j.jhsa.2011.03.002

[3] Dupuytren's contracture: a retrospective database analysis to assess clinical management and costs in England. BMC Musculoskeletal Disorders. 2011. DOI: 10.1186/1471-2474-12-73

[4] A Longitudinal Analysis of 281 Cases of Dermofasciectomy Efficacy in Advanced Dupuytren Disease Cases: A 20-Year Perspective. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2025.02.007

[5] Self-Perceived Hand Normality Before and After Surgical Treatment of Dupuytren Contracture. The Journal of Hand Surgery. 2021. DOI: 10.1016/j.jhsa.2021.01.022

[6] Surgical Trigger Finger Release Is Associated With New-Onset Dupuytren Contracture in the Short-Term Postoperative Period: A Matched Analysis. HAND. 2022. DOI: 10.1177/15589447221077375

[7] Limited Fasciectomy Versus Collagenase Clostridium histolyticum for Dupuytren Contracture: A Propensity Score Matched Study of Single Digit Treatment With Minimum 5 Years of Telephone Follow-Up. The Journal of Hand Surgery. 2021. DOI: 10.1016/j.jhsa.2021.05.022

[8] Microfasciectomy in Dupuytren’s disease: microsurgery in the evolution toward safer and more efficient fasciectomy and hand surgery. EFORT Open Reviews. 2023. DOI: 10.1530/eor-23-0033

[9] Treatment of Dupuytren’s contracture. The Bone & Joint Journal. 2018. DOI: 10.1302/0301-620x.100b9.bjj-2017-1194.r2

[10] Functional Benefit of Dupuytren’s Surgery. Journal of Hand Surgery. 2002. DOI: 10.1054/jhsb.2002.0776

[11] Surgical and therapy update on the management of Dupuytren's disease. Journal of Hand Therapy. 2014. DOI: 10.1016/j.jht.2013.10.006

[12] Variation in Treatment Recommendations for Dupuytren Disease. The Journal of Hand Surgery. 2017. DOI: 10.1016/j.jhsa.2017.08.023

[13] Challenges and innovations in the surgical treatment of advanced Dupuytren disease by percutaneous needle fasciotomy: indications, limitations, and medico-legal implications. Journal of Orthopaedic Surgery and Research. 2024. DOI: 10.1186/s13018-024-04844-3

[14] Recurrent Dupuytren’s disease after fasciectomy and collagenase injection are histologically indistinguishable. Journal of Hand Surgery (European Volume). 2020. DOI: 10.1177/1753193419900483

[15] Management of severe Dupuytren’s contracture of the proximal interphalangeal joint with use of a central slip facilitation device. Journal of Hand Surgery (European Volume). 2012. DOI: 10.1177/1753193412439673

[16] Finger Joint Contractures 5 Years After Treatment for Dupuytren Disease: A Comparative Cohort Study of Collagenase Injection Versus Surgical Fasciectomy. The Journal of Hand Surgery. 2022. DOI: 10.1016/j.jhsa.2022.04.019

[18] The case of a woman with bilateral Dupuytren’s contractures who developed CRPS-1 after fasciectomy with no relapse on subsequent collagenase clostridium histolyticum injection and manipulation of the other hand: Considerations for implementing a Budapest criteria checklist and assessing vasomotor instability by measuring differences in skin temperature. Journal of Hand Therapy. 2025. DOI: 10.1016/j.jht.2024.09.002

[19] Pre-operative hand therapy management of Dupuytren’s disease: A systematic review. Hand Therapy. 2024. DOI: 10.1177/17589983241227162

[20] Outcomes of Management of Recurrent Dupuytren Contracture: A Systematic Review and Meta-analysis. HAND. 2021. DOI: 10.1177/1558944721994220

[22] Effect of Perioperative Corticosteroid Administration on Early Postoperative Range of Motion and Functional Outcomes Following Dupuytren’s Fasciectomy. HAND. 2022. DOI: 10.1177/15589447221084013

[23] A review of the classification of Dupuytren’s disease. Journal of Hand Surgery (European Volume). 2015. DOI: 10.1177/1753193414560511

[24] One-year results of needle fasciotomy and collagenase injection in treatment of Dupuytren’s contracture: A two-centre prospective randomized clinical trial. Journal of Hand Surgery (European Volume). 2015. DOI: 10.1177/1753193415617385

[27] Hand Function and Quality of Life Before and After Fasciectomy for Dupuytren Contracture. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.04.029

[30] Outcome of arthrodesis for severe recurrent proximal interphalangeal joint contractures in Dupuytren’s disease. Journal of Hand Surgery (European Volume). 2020. DOI: 10.1177/1753193420960309

[32] Management of Dupuytren disease of the little finger. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-06176-2

[33] A systematic review identifying outcomes and outcome measures in Dupuytren’s disease research. Journal of Hand Surgery (European Volume). 2020. DOI: 10.1177/1753193420903624

[37] Prevalence and incidence of doctor-diagnosed Dupuytren’s disease: a population-based study. Journal of Hand Surgery (European Volume). 2017. DOI: 10.1177/1753193416687914

[40] A pilot study assessing the effectiveness of postoperative splinting after limited fasciectomy for Dupuytren’s disease. Journal of Hand Surgery (European Volume). 2012. DOI: 10.1177/1753193412437631

[43] Extensor mechanism dysfunction and hand deformities caused by Dupuytren’s disease: Surgical and rehabilitation perspectives. Journal of Hand Therapy. 2025. DOI: 10.1016/j.jht.2024.12.017

[44] Incidence of Dupuytren’s disease following hand trauma: a systematic review. Journal of Hand Surgery (European Volume). 2025. DOI: 10.1177/17531934251360545

[45] Modified McCash Technique for Management of Dupuytren Contracture. The Journal of Hand Surgery. 2017. DOI: 10.1016/j.jhsa.2017.01.018

[49] Postapproval Clinical Experience in the Treatment of Dupuytren's Contracture with Collagenase Clostridium Histolyticum (CCH): The First 1,000 Days. HAND. 2014. DOI: 10.1007/s11552-014-9645-7

[50] An uncomplicated and accurate approach to the measurement and reporting of Dupuytren’s contractures. Journal of Hand Surgery (European Volume). 2025. DOI: 10.1177/17531934251318896

[54] Healing after Bruner and McCash incisions for limited fasciectomy in patients with Dupuytren's disease: a randomized clinical trial. Journal of Hand Surgery (European Volume). 2025. DOI: 10.1177/17531934251315572

[57] Fasciectomy under local anaesthetic and adrenaline for Dupuytren’s contracture in a community setting in the UK with a cost analysis. The Bone & Joint Journal. 2020. DOI: 10.1302/0301-620x.102b10.bjj-2019-1685.r2

[58] Dupuytren in a Child: Rare Presentation of a Rare Clinical Entity. The Journal of Hand Surgery. 2016. DOI: 10.1016/j.jhsa.2016.08.011

[61] Likelihood of Dupuytren Contracture Recurrence After Limited Fasciectomy, Needle Aponeurotomy or Collagenase Clostridium histolyticum: Systematic Review of Prospective Data With 2- to 7-Year Follow-up. Journal of Hand Surgery Global Online. 2026. DOI: 10.1016/j.jhsg.2026.100979

[62] Determining Risk Factors and Rate of Surgery After Collagenase Injections for Dupuytren Contracture. Journal of Hand Surgery Global Online. 2025. DOI: 10.1016/j.jhsg.2025.100768

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2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.