Finally a controlled study comparing NA with Limited Fasciectomy (OS) has been reported in the prestigious Journal of Hand Surgery (American):

“Comparison of the Direct Outcomes of Percutaneous Needle Fasciotomy And Limited Fasciectomy for Dupuytren's Disease: a 6-Week Follow-Up Study

By van Rijssen, Annet L; Gerbrandy, Feike S J; Linden, Hein Ter; Klip, Helen; Werker, Paul M N

120 hands were randomly assigned to either NA of OS (Limited Fasciectomy). Two surgeons did all the procedures. Improvements in the PIP were reported as better using OS, though not with statistical significance. Improvement in the MCP was better with OS and was stat. significant. So, overall, this study indicated OS was more effecting in getting fingers straight. (There are three major reasons for this outcome I’ll discuss below)

“Major Complications” were reported at a rate of 5% with OS and ZERO percent with NA, showing that NA is far safer. This claim was vigorously made here on this Forum some time ago and was harshly debated. However, it is now backed up with a proper study. We had known about safety by tracking Eaton’s results. But now, for the first time, any one of us can refer a skeptical CHS to a study in their own most respected journal.
The Major Complications created by OS in this study were: “infection, skin slough, hematoma, transected artery, suspected digital nerve injury, re-exploration, and suspected division of a flexor tendon.”

The controversy of NA’s greater safety over OS is now *over*.

Now, regarding the reported greater effectiveness of OS over NA. Three flaws in the study design are evident:

1) All subjects had > 30 degrees contraction before entering the trial. However, NA can be done sooner than 30 D and with better results. When you stop a PIP contraction at 20 degrees and bring it back to straight with NA, that’s a powerful aspect of NA that did not show up in this study. The exclusion of NA’s ability to be done sooner than OS would unfairly skew the results away from NA.

2) Only one session of NA was allowed per hand. For Stages III and greater, NA is often done *more* than once to get the full benefit. This strength of NA was disallowed by the study design. To their credit, the authors acknowledge this. At the same time they state that OS proved more effective in later stages than NA, especially with the MCP. In rebuttal, it will be interesting to know Eaton’s now extensive clinical data on this.

3) The authors admit their inexperience with NA: “French rheumatologists were visited by the senior author before the commencement of the study.” Whoopee. Though easy to learn (and be safe), it is safe to say that more experienced NA CHS would have had better results with the tougher cases that were encountered by these NA beginners.

Nevertheless, in spite of the fact that NA went up against OS with two hands tied behind it’s back, NA came out fairly well. The timing of the article could not be better. Drs. Eaton/ Denkler and crew are due to speak to the ASSH on Friday, September 8th from 4:30 to 6 PM.

Ask your still skeptical CHS to read the article and go hear the presentation in September. They’ve wanted hard evidence published in their Journal. Fine. Here it is.

Knowing the intransigent rigidly of this profession, we can’t expect this one study to create a Sea Change overnight. But we as patients are increasingly being given the tools we need to finish the job we started in adding NA to our caregiver’s toolbox.
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Randy,

This is interesting, but you should not interject too much of your own opinion. No offense, but it would be best to promote the research without an editorial.

Its interesting, but I don't think means OS is wrong or unsafe. It does seem to reinforce the need to choose the best treatment for your particular case.

But, its a good fine.

No Name,
For thirty dollars you can buy the article yourself and place your own citique online. Put your money where your mouth is!

Link

http://www.sciencedirect.com/science?_ob=MImg&_imagekey=B6WJK-4K0C7B0-8-1&_cdi=6881&_user=10&_orig=search&_coverDate=05%2F31%2F2006&_qd=1&_sk=999689994&view=c&_alid=438479879&_rdoc=1&wchp=dGLzVzz-zSkzS&md5=3e1a42696c9c63c1de3af1f61c80d7eb&ie=/sdarticle.pdf

Randy:

I found your "editorial comments" about the study to be very helpful.

I also found it difficult to believe that one or two folks complained about your injecting your personal opinions.

Hey, I want to hear your opinions!

You are an incredible source of knowledge for us in the Dupuytrens Community. Why in the world would any intelligent person resist hearing what you have to say?

The Naysayers out there are entitled to post their opinions. In fact, I'd like to hear what they say too - especially if they demonstrate the same degree of knowledge & articulateness evidenced by your post.

Keep up the good work!

Mark

NA is safer than OS? Maybe, but it seems it also depends upon how advanced the disease is and that can only be measured on a patient-by-patient case and the claim that NA is safer is just not true.

It only be true if it is measuring "apples to apples" and clearly it is not.

So, what you are really saying is "we just don't know" and once again, the NA proponents are grabbing at straws.