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Complete annular and partial oblique pulley release for pediatric locked trigger thumb
1Hand Surgery Division INTEGRIS Baptist Medical Center and Orthopedic Surgery, Department University of Oklahoma, 3366 NW Expressway Suite 700, Oklahoma City, OK 73112 USA.
Hand (New York, N.Y.)
|December 2, 2011
Summary
Surgical release of pediatric locked trigger thumb requires addressing both the annular and oblique pulleys. Releasing 50% of the oblique pulley after annular pulley release effectively resolves the condition with high patient satisfaction.
Area of Science:
- Hand Surgery
- Pediatric Orthopedics
- Musculoskeletal Disorders
Background:
- Pediatric locked trigger thumb is a condition affecting the thumb's pulley system.
- Surgical intervention is often necessary to release the constricted pulleys and restore function.
Purpose of the Study:
- To evaluate the surgical treatment outcomes for pediatric locked trigger thumb.
- To assess the efficacy of sequential release of the annular pulley and partial release of the oblique pulley.
Main Methods:
- Retrospective review of 28 operative thumbs in 24 patients.
- Surgical technique involved complete annular pulley release and 50% proximal oblique pulley release.
- Postoperative assessment included bowstringing, Notta's node resolution, interphalangeal (IP) joint motion, and patient/parent satisfaction.
Main Results:
- The annular pulley was attenuated, and the proximal oblique pulley was stenotic.
- No recurrence of thumb locking or triggering was observed.
- Notta's node resolved in 19/20 thumbs; 5 thumbs had a mean 12° reduction in active IP joint flexion.
Conclusions:
- Complete annular pulley release combined with 50% proximal oblique pulley release is necessary for pediatric locked trigger thumb.
- This surgical approach leads to satisfactory outcomes, resolving triggering and Notta's node without significant bowstringing.
- Accurate identification of pulley pathology is crucial to avoid adverse results from over-release.
