When should I consider referring a patient with Dupuytren's contracture for surgical intervention?

Consider referring a patient with Dupuytren's contracture for surgical intervention when there is significant loss of hand function or established contracture. Referral should be made to a hand surgeon or a specialist in plastic or orthopaedic surgery from age 18 years onwards if contracture develops or function is significantly impaired.

For patients without contracture or significant loss of function, no treatment is necessary initially, but they should be advised about the progressive nature of the disease and to return for review if contracture develops, at which point referral is recommended.

Referral may also be considered for patients with painful nodules without contracture or loss of function, depending on clinical judgement, as corticosteroid injections might be beneficial in some cases.

Early referral is advised to optimize disease management and improve treatment outcomes, as untreated contractures usually progress and may not fully straighten with treatment if allowed to advance too far.