Delayed Manipulation after Collagenase Injection for Dupuytren Contracture: Two Case Reports and Consideration of Complications

Dupuytren disease is commonly treated with collagenase Clostridium histolyticum (CCH) injection followed by manual manipulation within 24–72 hours. Delays in manipulation may occur in clinical practice, yet data regarding outcomes beyond this window remain limited. In this case report, we describe two patients with Dupuytren contracture in whom manipulation was performed 14 and 21 days after CCH injection. Despite the prolonged interval, both patients achieved successful release of metacarpophalangeal joint contractures with meaningful functional improvement. Minor complications included palmar skin tearing at the time of manipulation, which healed without long-term sequelae. These cases demonstrate that successful manipulation beyond the recommended timeline is possible and warrants further investigation in larger studies.

Level of Evidence: Level V (Therapeutic)