Morpho-histological Analysis of the Ultrastructure of the Dupuytren Cord Subjected to Progressive Distraction Using an External Fixator

Background: This study aimed to provide a detailed morphological and ultrastructural characterization of Dupuytren disease cords in advanced stages, with particular attention to the effects of progressive mechanical distraction on extracellular matrix organization and tissue architecture. Methods: Six patients with stage IV Dupuytren disease affecting the fifth ray were included. Three underwent treatment with a distractible angular external fixator followed by open fasciectomy, while 3 controls received open fasciectomy alone. Excised cords were analyzed by light microscopy and scanning electron microscopy, with additional morphometric assessment of collagen organization. Results: Distracted samples showed increased cellularity, enhanced fascicular definition, and greater peripheral vascularization. At ultrastructural level, a more regular and modular arrangement of collagen was observed, with thicker and more widely spaced low-density regions compared with controls. Quantitative analysis confirmed a significant increase in thickness (9.23 ± 0.91 µm vs 7.33 ± 0.75 µm; P = .041) and spacing (21.3 ± 2.4 µm vs 13.4 ± 1.7 µm; P = .009), alongside a reduced linear fraction of these regions (52.4% ± 2.3% vs 59.5% ± 3.2%; P = .032). Conclusions: Progressive distraction induces substantial remodeling of Dupuytren disease cords, resulting in a more cellular and structurally organized extracellular matrix. These findings suggest that mechanical stimulation contributes not only to contracture correction but also to modification of the underlying fibrotic architecture, potentially improving surgical handling and providing a more favorable structural substrate for subsequent surgical intervention.