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Percutaneous release, open surgery, or corticosteroid injection, which is the best treatment method for trigger
Jia Wang1, Jia-Guo Zhao, Cong-Cong Liang
1Department of Traumatic Orthopaedics, Tianjin Hospital, Tianjin, China.
Background:
Percutaneous A1 pulley release surgery for trigger digit (finger or thumb) has gained popularity in recent decades. Although many studies have reported the failure rate and complications of percutaneous release for trigger digit, the best treatment for trigger digit remains unclear.
Questions/Purposes:
Our aim was to identify the relative risk of treatment failure, level of satisfaction, and frequency of complications, comparing percutaneous release with open surgery or corticosteroid injections for adult patients with trigger digits.
Methods:
We searched PubMed, Embase, and the Cochrane Library for randomized controlled trials (RCTs), comparing percutaneous release with open surgery or corticosteroid injections. Seven RCTs involving 676 patients were identified. Methodologic quality was assessed by the Detsky quality scale. After data extraction, we compared results using a fixed meta-analysis model.
Results:
There were no differences in the failure rate (risk ratio [RR] = 0.93; 95% CI, 0.14-6.25) and complication frequency (RR = 0.83; 95% CI, 0.15-4.72) between patients undergoing percutaneous release and open surgery. Patients treated with percutaneous release had fewer failures (RR = 0.07; 95% CI, 0.02-0.21) and a greater level of satisfaction (RR = 2.01; 95% CI, 1.62-2.48) compared with the patients treated with corticosteroid injections. We found no difference in complication frequency between percutaneous release and corticosteroid injection (RR = 3.19; 95% CI, 0.51-19.91).
Conclusions:
The frequencies of treatment failure and complications were no different between percutaneous release surgery and open surgery for trigger digit in adults. Patients treated with percutaneous releases were less likely to have treatment failure than patients treated with corticosteroid injections.
