Surgical release of the pediatric trigger thumb
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Published on: May 26, 2023
Daniel J Marek1, Franck Fitoussi, Deborah C Bohn
1Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN 55454, USA.
Insights
Surgical release is a safe and effective treatment for locked pediatric trigger thumb (PTT). This study found excellent outcomes and high surgeon preference for surgical intervention in locked cases.
Area of Science:
- Orthopedics
- Pediatric Hand Surgery
Background:
- Pediatric trigger thumb (PTT) has variable reported spontaneous recovery rates (24-66%).
- Previous studies suggested conservative management for PTT.
Purpose of the Study:
- To review surgical outcomes for PTT.
- To survey pediatric hand surgeons' treatment practices for PTT.
Main Methods:
- Retrospective review of 217 thumbs in 173 pediatric patients undergoing surgical release for PTT.
- Email survey of 27 pediatric hand surgeons on treatment preferences for locked and intermittently triggering thumbs.
Main Results:
- Postoperative range of motion significantly improved, with an average loss of 1° extension compared to 36° preoperatively.
- No major complications or recurrences were noted at an average follow-up of 4.2 years.
- 85% of surgeons would surgically release a locked PTT, while 52% would observe an intermittently triggering thumb.
Conclusions:
- Surgical release is a short, safe, and effective treatment for locked PTT.
- Specialty-trained hand surgeons prefer surgical release for locked PTT.
- Observation may be considered for intermittently triggering thumbs if asymptomatic.
Purpose:
The spontaneous recovery rate for locked pediatric trigger thumb (PTT) has recently been reported at between 24% and 66%; these studies concluded that a conservative approach for this condition could be adopted. The aims of this study were to review our results of surgical release of the PTT and to survey pediatric hand surgeons regarding their practice patterns for treatment of the PTT.
Methods:
After institutional review board approval, we retrospectively reviewed 173 consecutive patients with 217 thumbs treated surgically at our institution. An e-mail survey of 27 pediatric hand surgeons questioned treatment of a 2-year-old child with a 6-month history of a locked trigger thumb and of an intermittently triggering thumb.
Results:
The retrospective review demonstrated that preoperative range of motion averaged 36° loss of extension (range, 0° to 90°; SD, 22°); postoperative range of motion averaged 1° loss of extension (range, 0° to 30°; SD, 7°) at 27-day follow-up. Using a parent questionnaire at an average follow-up of 4.2 years, there were no major complications or recurrences identified. Five thumbs developed minor skin complications that healed with conservative management. There were no secondary surgeries. The practice pattern survey demonstrated that 85% of pediatric hand surgeons would treat a locked PTT in a 2-year-old with surgical release and 52% would treat an intermittently triggering thumb in a 2-year-old with continued observation if the triggering thumb was not painful.
Conclusions:
The surgical results reported in this study, along with the practice pattern survey, confirm that surgical release is a short, safe, and effective procedure when performed by specialty trained hand surgeons, and it is the treatment of choice for a locked PTT.