Needle fasciotomy versus limited fasciectomy for treatment of Dupuytren’s contractures of fingers: a randomised non-inferiority trial.
Dupuytren’s contractures are scar-like tissue that form under the skin of the palm of the hand, causing one or more fingers to bend into the palm (www.nhs.uk/conditions/dupuytrens-contracture). They prevent them from straightening fully which causes difficulty with many everyday tasks like washing, dressing, or using a computer keyboard. It is common.
Dupuytren’s contractures are most commonly treated using one of two procedures and we don’t know which is best.
- Needle fasciotomy involves cutting the contracture by moving a medical needle back and forth through it until it snaps, releasing the finger. It can be done in a clinic room and leaves no skin wound. Recovery takes 1-2 weeks
- Limited (regional/selective) fasciectomy involves cutting out the contractures and stitching the skin up. This is done in an operating theatre with the patient asleep or the arm “frozen”. Recovery takes 4-12 weeks.
In 2016 NHS England spent £36M treating 16,700 patients with Dupuyten's contractures. The problem can come back (recur) after either treatment. Studies suggest that this happens sooner and more commonly with needle fasciotomy, but limited fasciectomy has a greater risk of causing other problems which restrict hand function, like finger stiffness and pain. Needle fasciotomy is cheaper for the NHS, but any savings may be offset by an increased need for future treatments after recurrence.
The aim of this NIHR funded study is to determine:
- whether needle fasciotomy is not substantially worse than limited fasciectomy at preserving hand function?
- which treatment offers best value for money?
The study is endorsed by the BSSH and co-ordinated at the Nottingham Clinical Trial Unit. The Chief investigator is Tim Davis. The study is part of the NIHR Clinical Research Network Portfolio and the NIHR associate-PI scheme which allows, and acknowledges, trainee/nurse/therapist support of Principal Investigators. Recruitment was delayed by the coronavirus pandemic and started in March 2022. 11 sites around the UK are presently active.
Further details regarding the study are available at:
If you would like more information, to ask any questions or to join Hand-2 as a recruiting site, please email the study team.