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Trigger thumbs in children: results of surgical release
1Department of Orthopaedics and Traumatology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong. leungoy@ha.org.hk
Insights
Surgical release effectively treats pediatric trigger thumbs, especially in children over one year old. This procedure offers good outcomes with few complications, making it a recommended option for this condition.
Area of Science:
- Pediatric Surgery
- Orthopedics
- Hand Surgery
Background:
- Trigger thumb (stenosing tenosynovitis) is a common condition in children.
- It presents as a flexion deformity and catching of the thumb.
- Surgical intervention is often considered for persistent cases.
Purpose of the Study:
- To evaluate the surgical outcomes and complications of trigger thumb release in children.
- To identify factors influencing surgical success in pediatric trigger thumb cases.
Main Methods:
- A retrospective descriptive case series was conducted.
- Data from 180 children (209 trigger thumbs) treated between 1993 and 2009 were analyzed.
- Patient demographics, clinical presentation, surgical approach, and outcomes were reviewed.
Main Results:
- The mean age of onset was 19 months, with most diagnosed after one year of age.
- Over 95% of thumbs treated with transverse incision achieved good range of motion and minimal scarring.
- Residual flexion deformity occurred in only 4%, primarily in those operated on before age one.
Conclusions:
- Surgical release is a safe and effective treatment for pediatric trigger thumbs.
- Optimal results are achieved when surgery is performed in children over one year of age.
- The transverse incision technique yields satisfactory outcomes with low complication rates.
Abstract:
OBJECTIVE. To evaluate results from surgical release of trigger thumbs in children in a regional hospital cluster in Hong Kong. DESIGN. Descriptive case series. SETTING. A regional hospital cluster, Hong Kong. PATIENTS. Data from 1993 to 2009 on 180 children with 209 trigger thumbs were collected. Analyses into gender, predominance of thumb, age of onset, associated abnormalities and family history, symptoms and signs, surgical outcomes, and postoperative complications were carried out retrospectively. RESULTS. There were 92 girls and 88 boys having trigger thumbs (1.05:1). In all, 29 (16%) of the children presented with bilateral trigger thumbs, while the right thumb was singly involved in 81 (45%) and the left thumb in 70 (39%) of the children. The mean age of onset was 19 months; only 20% were diagnosed before the age of 1 year. Only nine (5%) of the children were associated with congenital diseases and none had a positive family history of trigger thumb. Flexion deformity was the major presenting feature, other than triggering or pain. A nodule and flexion deformity were very commonly observed during physical examination. More than 95% of the operated thumbs with transverse incision acquired a good range of movement with a scarcely apparent scar. A residual flexion deformity was evident in only 4%, mostly in children who underwent surgical release under the age of 1 year. CONCLUSION. Surgical release is recommended for children with trigger thumbs aged more than 1 year, which attains satisfactory results with minimal complications.
