NEON is a randomised controlled trial funded by the National Institute of Health Research (NIHR) Health Technology Assessment (HTA), led by Professor Abhilash Jain, and coordinated from the Surgical Intervention Trials Unit at the University of Oxford.

Digital nerve injuries are the most common nerve injury treated surgically in the UK. They cause loss of sensibility and can be associated with injuries to the flexor tendons and/or finger joint capsules. Treatment for digital nerve injuries typically involves direct end-to-end microsurgical repair of the cut nerve ends in an operating room by a specialist surgeon.

However, clinical uncertainty surrounds the efficacy of digital nerve repair. A recent systematic review highlighted the absence of randomised controlled trials and the lack of studies using patient reported outcome measures. Results of non-comparative observational studies showed that surgical repair led to sensory recovery to pre-injury levels in a minority of patients, whilst patients with injuries that were not repaired declined further surgical intervention to improve their sensibility. The BSSH identified the repair of digital nerves as a health resource topic to study, confirmed through a James Lind Alliance Priority Setting Exercise.

The NEON study seeks to answer whether microsurgical digital nerve repair is clinically effective, by comparing two surgical procedures. Eligible patients will have surgery, exploration, washout and repair of all other structures. Additionally 50% of patients will be randomised to traditional nerve repair, 50% to nerve alignment without sutures. After treatment, patients will be asked to complete questionnaires about their hand and their recovery, and to attend clinical assessments to complete sensory tests.

NEON is part of the NIHR Clinical Research Network Portfolio and the NIHR associate-PI scheme. It received research ethics committee approval in February 2020 and, despite delays with COVID-19, opened to recruitment in September.

Further details regarding the study are available at:

NEON study website: https://neon.octru.ox.ac.uk/

ISRCTN study registration: https://www.isrctn.com/ISRCTN16211574

NIHR study information: https://fundingawards.nihr.ac.uk/award/NIHR127807

The NEON trial is now closed and the trial data is being analysed for publication later this year

Joe Dias, Professor of Hand and Orthopaedic Surgery in the Department of Health Sciences at the University of Leicester and his colleagues at Leicester’s Hospitals have been awarded a National Institute of Health Research (NIHR) Health Technology Assessment (HTA) grant of just under £2million for the Dupuytren’s Interventions Surgery vs. Collagenase (DISC) Trial.

The importance of this research remains, Dupuytren’s Contracture is the fourth most common problem affecting the hand in the UK. The disorder, occurring mostly in adult men, is caused by fibrous tissue forcing the finger to bend down into the palm of the hand. Although it is rarely painful, patients cannot straighten the finger and this increasingly interferes with hand function.

The most common and accepted treatment method is surgery to straighten the bent finger by removing the fibrous tissue. Each year, surgery is performed on around 17,000 patients in England which costs the NHS over £60 million.

An alternative method to surgery is a newly introduced Collagenase injection (CCH) which softens the fibrous tissue. Administered in clinic, with a follow up clinic appointment a few days later, the finger is manipulated in an attempt to straighten it.

The National Institute of Health and Clinical Excellence (NICE) has recently (July 2017) updated their guidance on the use of collagenase (Technology Assessment 459), and acknowledge that the DISC trial and the findings it will generate will be crucial in determining if the injection is no worse than surgery and whether the effects are sustained in the long-term.

Further details regarding the study are available at:

BioMed Central 

The DISC trial is no longer recruiting patients to take part, however, if you require any further information about this study, please do not hesitate to contact the Trial Management Team for further information via the channels below. 

If you have a media or scientific enquiry, Dr Puvan Tharmanathan: puvan.nathan@york.ac.uk

(Information updated Sept 2024)

The DRAFFT-2 trial has completed recruitment and will now begin its follow up phase. Click here to visit the official webpage for the trial.

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 was 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 were active. 

Further details regarding the study are available at: 

HAND-2 study website

ISRCTN study registration

NIHR website

Associate Principal Investigator (PI) Scheme

The Hand-2 trial closed to recruitment on 31st January 2024, after successfully recruiting the full sample of 406 patients with Dupuytren’s contractures. Hand-2 plans to follow-up all participants to two years after receiving treatment. Results are expected to be published in late 2027.

We would like to acknowledge and thank staff across the 19 open Hand-2 sites for their hard work and unending motivation during the recruitment process, and for their continued support as we continue with treatment administration and follow-ups.

The results of this trial are available via the links below:

• The Lancet
• ScienceDirect