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['Trigger thumb' in 38 children: good short-term and long-term results from surgery]
M P van den Borne1, F J Custers, J P van der Aa
1Onze Lieve Vrouwe Gasthuis, afd. Orthopedie, Amsterdam.
Insights
Surgical pulley incision effectively treats pediatric trigger thumb (tendovaginitis stenosans), offering excellent long-term results with minimal complications. Early surgical intervention is recommended if conservative measures fail within six months.
Area of Science:
- Pediatric Orthopedics
- Hand Surgery
- Musculoskeletal Disorders
Context:
- Trigger thumb, or tendovaginitis stenosans, is a common condition in children.
- It results from a congenital constriction of the A1 pulley, leading to a palpable nodule and restricted thumb movement.
- Surgical intervention, specifically pulley incision, is a treatment option for persistent cases.
Purpose:
- To evaluate the short-term and long-term efficacy of pulley incision for pediatric trigger thumb.
- To assess the complication rate associated with the surgical procedure.
- To determine the optimal timing for surgical intervention in pediatric trigger thumb cases.
Summary:
- A retrospective study reviewed 45 pediatric trigger thumbs operated on between 1984 and 1995.
- Follow-up, at least two years post-surgery, showed excellent functional recovery in all thumbs.
- Nodules resolved, and complications were minimal, with only minor issues requiring revision in two cases.
Impact:
- Pulley incision demonstrates excellent long-term effectiveness for pediatric trigger thumb.
- The procedure has a low complication rate, making it a safe and viable treatment option.
- The study supports surgical intervention for trigger thumb unresponsive to conservative management for six months.
Objective:
To determine the direct and long-term effectivity of incision of the pulley in a trigger thumb (tendovaginitis stenosans).
Design:
Retrospective study with follow-up.
Methods:
In the period 1984-1995, 38 children (24 boys and 14 girls) were diagnosed and operated on 45 trigger thumbs in the Onze Lieve Vrouwe Gasthuis (Amsterdam) and Medisch Centrum Alkmaar, the Netherlands. Data were obtained from notes, operation reports and review in follow-up, at least 2 years after the operation.
Results:
The mean age of the children at the moment of surgery was 3 years and 2 months (range: 11 months-10.33 years). 39 out of 45 thumbs were reviewed. Four thumbs had limited postoperative function. Two of these had a revision operation. There was 1 thumb with a postoperative superficial infection. At follow-up all thumbs had maximal function. The nodule in the tendon, which was palpable in 43 out of 45 thumbs preoperatively, had (almost) disappeared in all 39 thumbs at follow-up. There was a family history of trigger thumb in 33% of the 33 patients with follow up. 18% had bilateral involvement of the thumbs. The 6 digits not included in follow-up had a normal function according to the last notes.
Conclusion:
The results of surgery in the short term are good, in the long term excellent. Few complications occur. Based on the findings, it seems advisable to operate on children with a trigger thumb if there is no spontaneous recovery within half a year. Trigger thumb is the result of a congenital tight pulley.