Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2025 Sep 2;112(9):znaf174.
doi: 10.1093/bjs/znaf174.

The NEON (Nerve rEpair Or Not) trial: a randomized controlled trial of microsurgical repair versus nerve alignment for digital nerve injury

Justin C R Wormald  1   2 , Matthew D Gardiner  1   3 , Christina Jerosch-Herold  4 , Jonathan Cook  1 , Rafael Pinedo Villanueva  1 , Ciaron O'Hanlon  1 , Naomi Vides  1 , Gianluca Fabiano  1 , Scott Parsons  1 , Loretta Davies  1 , Heidi Fletcher  1 , Molly Glaze  1 , Cushla Cooper  1 , Dominic Power  5 , Abhilash Jain  1   6 , David Beard  1   7 ; NEON study group
Collaborators, Affiliations
Randomized Controlled Trial

The NEON (Nerve rEpair Or Not) trial: a randomized controlled trial of microsurgical repair versus nerve alignment for digital nerve injury

Justin C R Wormald et al. Br J Surg. .

Abstract

Background: Digital nerves provide sensibility to the fingers. They are commonly injured through accidental sharp laceration. The aim of the NEON (Nerve rEpair Or Not) study was to investigate whether microsurgical suture repair of lacerated digital nerves is superior to nerve alignment alone without suture repair.

Methods: A two-arm, parallel group, double-blind, multicentre RCT was undertaken over 2 years. Participants with suspected unilateral digital nerve injury underwent surgical exploration and were randomized to microsurgical suture repair or nerve alignment alone. The primary outcome was the Impact of Hand Nerve Disorders (I-HaND v2) patient-reported outcome measure (PROM) at 12 months post-randomization. Secondary outcomes assessed were: objective neurosensory and functional recovery; health-related quality of life to examine cost-effectiveness; complications of surgery and clinically problematic neuroma rates (Elliot score). Both participants and assessors were blind to allocation.

Results: A total of 122 adults were randomized to microsurgical suture repair (n = 61) or nerve alignment alone (n = 61). Primary outcome data using the I-HaND (v2) were available for 106 participants (87%) at 12 months. There were no statistically significant differences in I-HaND scores at all time points, including the 12-month primary end point (15.9 versus 20.2, P = 0.09; 95% c.i. [-0.9, 10.8]). There were also no differences in all secondary outcome measures, including Patient Evaluation Measure and EQ-5D-5L scores at 12 months. Complications were similar at 6 weeks and 12 months. The trial was closed early by the funder owing to slow recruitment and did not reach the intended sample size.

Conclusion: Based on the available data from the NEON trial, there is no evidence to support the beneficial effect of suture repair over nerve alignment alone for isolated digital nerve injury. This multicentre RCT can be used to inform future trials, inform patients and guide clinical practice.

Funding: NIHR Health Technology Assessment (NIHR127807-18/37).

Trial registration number: ISRCTN16211574.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Participant flow diagram for the NEON study
Fig. 2
Fig. 2
Schematic diagram showing digital nerve anatomy Grey shading denotes zone of injury for inclusion into the trial. Dark shading denotes zone of injury in the ‘critical zones’, a minimization factor in the study.
Fig. 3
Fig. 3
CONSORT diagram
See this image and copyright information in PMC

References

    1. Manley OWG, Wormald JCR, Furniss D. The changing shape of hand trauma: an analysis of Hospital Episode Statistics in England. J Hand Surg Eur 2019;44:532–536 - PubMed
    1. Herbert A, Wijlaars L, Zylbersztejn A, Cromwell D, Hardelid P. Data resource profile: hospital episode statistics admitted patient care (HES APC). Int J Epidemiol 2017;46:1093–1093i - PMC - PubMed
    1. Evertsson L, Carlsson C, Turesson C, Ezer MS, Arner M, Navarro CM. Incidence, demographics and rehabilitation after digital nerve injury: a population-based study of 1004 adult patients in Sweden. PLoS One 2023;18:e0283907. - PMC - PubMed
    1. Padovano WM, Dengler J, Patterson MM, Yee A, Snyder-Warwick AK, Wood MD et al. Incidence of nerve injury after extremity trauma in the United States. Hand (N Y) 2020;17:615–623 - PMC - PubMed
    1. Frostadottir D, Ekman L, Zimmerman M, Andersson S, Arner M, Brogren E et al. Cold sensitivity, functional disability and predicting factors after a repaired digital nerve injury. Sci Rep 2022;12:4847. - PMC - PubMed

Publication types