Level I RCT comparing percutaneous needle fasciotomy (PNF) to limited fasciectomy (LF) for Dupuytren's disease. 113 patients (166 rays) were randomized and followed at 1 and 6 weeks. The study tests whether PNF's claimed advantages — rapid recovery, low complications, equivalent correction — hold up against LF in a controlled setting.
The choice between PNF and fasciectomy for Dupuytren's comes down to one variable: Tubiana stage. For stage I or II disease (TPED ≤ 90°), PNF delivers equivalent correction with zero major complications and functional recovery within days. This is the right operation for the anticoagulated patient, the bilateral case needing staged treatment, or anyone who cannot afford weeks off work.
For stage III or IV, do not offer PNF as equivalent — it achieves roughly half the correction of fasciectomy at these stages (46–47% vs 75–79%). Steer these patients toward limited fasciectomy.
Regardless of technique, counsel patients preoperatively that the PIP joint is the hardest to correct. Neither procedure reliably normalizes PIP contracture at 6 weeks, and this paper provides the data to support that conversation.
Level I RCT comparing percutaneous needle fasciotomy (PNF) to limited fasciectomy (LF) for Dupuytren's disease. 113 patients (166 rays) were randomized and followed at 1 and 6 weeks. The study tests whether PNF's claimed advantages — rapid recovery, low complications, equivalent correction — hold up against LF in a controlled setting.
The choice between PNF and fasciectomy for Dupuytren's comes down to one variable: Tubiana stage. For stage I or II disease (TPED ≤ 90°), PNF delivers equivalent correction with zero major complications and functional recovery within days. This is the right operation for the anticoagulated patient, the bilateral case needing staged treatment, or anyone who cannot afford weeks off work.
For stage III or IV, do not offer PNF as equivalent — it achieves roughly half the correction of fasciectomy at these stages (46–47% vs 75–79%). Steer these patients toward limited fasciectomy.
Regardless of technique, counsel patients preoperatively that the PIP joint is the hardest to correct. Neither procedure reliably normalizes PIP contracture at 6 weeks, and this paper provides the data to support that conversation.