Training

A good introduction to the technique might be below video from Charles Eaton, the pioneer of PNF in the USA

                         http://www.youtube.com/watch?v=yFpGvkDaywI

The French training program called "Ecole Dupuytren" (Dupuytren school) and consisting of 5 half-day sessions  doesn't seem to be available anymore. It used to be free of charge and we would very much appreciate any comments on its availability. The training used to be provided by a non-profit organization headed by Drs. Henri Lellouche (email: henrilel /at/ noos.fr) and Marie-Pascale Manet of the Viggo Petersen Center - Hôpital Lariboisière
 2 rue Ambroise Paré - 75 010 Paris - France. Phone : +33 / 1 / 49 95 63 06.

  

Literature and Links

A good overview on the NA technique, associated success rates and risks, and recurrence rates compared to surgery is given in a paper by Lermusiaux et al. of 1997 dup_lermusiaux_page1 and dup_lermusiaux_page2 (complete text, provided with permission by Dr. Lermusiaux).

A recent overview of needle faciotomy (abbreviated as PNF or NA) by Charles Eaton, pioneer of NA in the USA, describes the technique in detail, its indication and contraindication, and gives recommendations to avoid potential pitfalls. "Percutaneous Fasciotomy for Dupuytren’s Contracture" J Hand Surg 2011;36A:910–915. Abstract. Reprints available via the author or the Dupuytren Society.

Van Rijssen et al. started a randomized trial comparing PNF and surgery. The 5-year results have now been published. Annet van Rijssen, Hein ter Linden, Paul M. N. Werker "Five-Year Results of a Randomized Clinical Trial on Treatment in Dupuytren’s Disease: Percutaneous Needle Fasciotomy versus Limited Fasciectomy" Plastic Reconstr Surg 129 (2012) p 469–477.  abstract In this paper the authors additionally compare with published data on collagenase injection and conclude "These results indicate that the recurrence rate after collagenase is considerably higher than after limited fasciectomy and percutaneous needle fasciotomy."

James Donaldson and Nicholas Goddard "The Re-Emergence of Percutaneous Fasciotomy in the Management of Dupuytren’s Disease" Open Orthop J 6 (2012) p 83–87. Full_text . The authors conclude "Percutaneous needle fasciotomy has been shown to be beneficial in Dupuytren’s disease and the short-term structural efficacy is well documented. It is a simple and quick method, with a short sick leave period for the patient, limited care requirements and a low overall cost. ... Better results are seen at earlier stages and with more proximal disease. It must, however, be practised by experienced clinicians with an understanding of the anatomy and patho-anatomy of Dupuytren’s contractures to minimise any potential complications."

Analyzing 100 patients Foucher et al. find a recurrence rate of 58 % after a mean follow-up of 3.2 years (recurrence defined as the need of another treatment). They conclude " The ideal indication for this simple and reliable technique is an elderly patient with a bowing cord and predominant MP contracture". G. Foucher, J. Medina, and R. Navarro "Percutaneous needle aponeurotomy: complications and results" The Journal of Hand Surgery: Journal of the British Society for Surgery of the Hand 28 (2003) p 427-431. Abstract.

In September 2008 Gary Pess presented on the Annual Meeting of the American Society for Surgery of the Hand (ASSH) his results on performing NA on 128 patients (260 fingers). After an obervation period of 2.5 - 3.5 years he finds a recurrence rate of 14 % for MCP joints and 54 % for PIP joints.

McMillan and Binhammer report results of a 6-months-trial on the combination of NA and steroid injection (JHS 37 (2012):p1307-1312). The steroid group showed better outcome. Abstract. See also comments fom Borekstra and Werker (JHS 37 (2012):p2429-2430).

A wealth of literature on Dupuytren's contracture, not just on NA, is cited on Dupuytren_foundation .

Keith Denkler reports successful treatment of 102 patients with Dupuytren's contracture stage 4 "Needle Aponeurotomy for Stage IV Dupuytren’s Contracture: A Wide Awake First Step Approach" 2009 Annual Meeting of the American Association of Plastic Surgeons abstract and Full_AAPS_209_PDF (provided by author).

A comparison of NA and hand surgery (limited fasciotomy) concludes that in the short term and in cases with a contracture of 90 degrees or less NA is a good treatment alternative to surgery, specifically in stages I and II (A. L. van Rijssen et al. "A comparison of the direct outcomes of percutaneous needle fasciotomy and limited fasciectomy for Dupuytren's disease: a 6-week follow-up study" The Journal of hand surgery, Vol. 31 (5), p 717-725).

AL van Rijssen and PM Werker "Percutaneous needle fasciotomy in dupuytren's disease" J Hand Surg [Br]. 31 (2006) p 498-501 abstract. After 32 months they report a recurrence rate of 65 %. The authors do not indiate whether and how long patients were wearing night splints after they had NA.

Walt Stagner has a place in the hall of fame for pioneering NA in the US. As a patient he had taken a video of his French NA and distributed it in the US. An innovative approach that successfully motivated doctors to offer NA. Walt's site offers his own experience, testimonials from patients, explanation of Dupuytrens, and a lot of related links.

Patients from the UK might be interested in publications by NICE. Note that NICE calls NA "needle fasciotomy" (sometimes also Percutaneous Needle Fasciotomy = PNF), different names for the same procedure. A NICE information for the public approves NA: " "Your doctor may have offered you needle fasciotomy. NICE has considered this procedure because it is relatively new. NICE has decided that the procedure is safe enough and works well enough for use in the NHS." An overview of NICE papers regarding needle fasciotomy is on NICE_PNF_papers.

A lot of the original French literature is listed on Frenchlit. The above cited paper by Foucher et al. is available on the Internet as abstract.


Page last modified: 01/11/2017