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Pediatric trigger thumb with locked interphalangeal joint: can observation or splinting be a treatment option?
Shukuki Koh1, Emiko Horii, Tatsuya Hattori
1Department of Orthopedic Surgery, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan. skoh@med.nagoya-u.ac.jp
Insights
A splint effectively treated pediatric trigger thumb, resolving symptoms in 92% of cases within 22 months. This condition is self-limiting, and late surgery is a safe option for persistent snapping.
Area of Science:
- Pediatric Orthopedics
- Hand Surgery
- Developmental Pediatrics
Background:
- Pediatric trigger thumb, characterized by a locked interphalangeal joint, presents a unique clinical challenge.
- Understanding its natural history and treatment outcomes is crucial for effective management.
Purpose of the Study:
- To investigate the natural history of pediatric trigger thumb with a locked interphalangeal joint.
- To evaluate the efficacy of splinting as a conservative treatment.
- To assess the outcomes of late surgical intervention for residual symptoms.
Main Methods:
- Retrospective review of medical records for 64 pediatric patients diagnosed with trigger thumb.
- Comparison of treatment outcomes between a splint group and an observation group.
- Analysis of surgical intervention for patients with persistent snapping after conservative management.
Main Results:
- Splint treatment led to complete symptom relief in 92% of patients within 22 months, significantly faster than the 60% resolution in the observation group over 59 months.
- Most patients experienced improvement from locking to snapping, with one case of bilateral involvement showing differential resolution.
- Four patients undergoing late surgery (age 8+) for residual snapping experienced no complications or deformities.
Conclusions:
- Splinting is an effective method for accelerating symptom resolution in pediatric trigger thumb.
- The condition demonstrates a self-limiting natural history, suggesting conservative management is often sufficient.
- Late surgical intervention is a safe and viable option for persistent snapping, offering a valuable treatment choice for patients and families.
Background:
The purpose of this study is to report the natural history of pediatric trigger thumb with locked interphalangeal joint, the efficacy of a splint for this condition, and the outcome of late surgery.
Methods:
Medical records of 64 patients were retrospectively reviewed. Patients were treated with a coil splint when parents and patients accepted; otherwise, regular observation was conducted. Splint application and/or observation were terminated either when the patient gained full range of active motion without snapping, or underwent surgical intervention.
Results:
In splint group, 92% of the patients experienced complete symptom relief in 22 months, whereas 60% resolved completely in 59 months in observation group. The differences were statistically significant. One thumb in a patient with bilateral involvement remained locked while the other completely resolved. The rest of the patients also showed improved symptom from locking to snapping. Four patients with residual snapping underwent surgery at the age of 8 years and above without any deformity and complication.
Conclusions:
Splint was efficient in shortening the time for symptom relief; however, the natural history revealed the self-limiting nature of this condition. Late surgery was safe and effective for residual snapping and can be presented as one treatment option to the patients and families, combined with conservative treatment.
Level Of Evidence:
Level III--retrospective comparative study.
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