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Percutaneous trigger thumb release in children
Miguel Angel Ruiz-Iban1, Pedro Gonzalez-Herranz, Jose A Lopez Mondejar
1Departamento de Cirugía Ortopédica y Traumatología, Hospital Ramón y Cajal, Madrid, Spain. drmri@hotmail.com
Insights
Percutaneous A1 pulley release effectively treats pediatric trigger thumb in children under 6. This minimally invasive procedure offers a safe and successful option with excellent long-term outcomes.
Area of Science:
- Pediatric Orthopedics
- Hand Surgery
- Minimally Invasive Procedures
Background:
- Trigger thumb, a common condition in children, causes thumb flexion contracture.
- Surgical intervention is often necessary for persistent cases.
- A1 pulley release is a standard surgical approach.
Purpose of the Study:
- To evaluate the efficacy and safety of percutaneous A1 pulley release for pediatric trigger thumb.
- To assess functional outcomes and complications following the procedure.
Main Methods:
- Prospective evaluation of 23 children (27 trigger thumbs) under 6 years old.
- Treatment involved percutaneous A1 pulley release in an ambulatory setting.
- Follow-up included assessment of range of motion, strength, sensibility, and triggering for at least 1 year.
Main Results:
- Excellent results achieved in 25 out of 27 treated thumbs, with no residual triggering.
- Two thumbs showed transient metacarpophalangeal extension deficits, resolving with exercises.
- One thumb relapsed, requiring open release; no other significant complications were noted.
Conclusions:
- Percutaneous A1 pulley release is a safe and effective treatment for pediatric trigger thumb.
- The procedure demonstrates high success rates and minimal complications.
- It offers a viable alternative to open surgery for this condition.
Abstract:
The objective of this study was to determine whether percutaneous release of the A1 pulley is an adequate treatment of trigger thumb in children. Twenty-three children under the age of 6 years with 27 trigger thumbs fixed in flexion were evaluated prospectively. All were treated with a percutaneous release of the A1 pulley in an ambulatory setting and followed for at least 1 year. Interphalangeal and metacarpophalangeal joint range of motion, pinch strength, static two-point discrimination sensibility, and triggering were examined and compared with the unaffected thumb at the end of follow-up. After a mean follow-up of 3 years, 25 of the thumbs had an excellent result without residual triggering. Two of these thumbs had mild metacarpophalangeal extension deficit 1 month after surgery that resolved completely with specific exercises. One thumb relapsed and required subsequent open release and was considered a poor result. One child was lost to follow-up. There were no sensibility defects, strength loss, interphalangeal motion loss, or metacarpophalangeal hyperextension deformities. Percutaneous release of the A1 pulley is an effective and safe option in the treatment of trigger thumb in children.
