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Percutaneous trigger thumb release in children: neither effective nor safe
Julio J Masquijo1, Andres Ferreyra, Lucas Lanfranchi
1*Department of Pediatric Orthopaedics, Sanatorio Allende, Córdoba, Argentina †ABC Medical Center, Mexico City, México.
Journal of Pediatric Orthopedics
|December 11, 2013
Summary
Percutaneous trigger thumb release in children showed incomplete A1 pulley release in 70% of cases and flexor tendon injuries in 80%. This technique is not recommended for pediatric trigger thumb treatment due to safety concerns.
Area of Science:
- Pediatric Orthopedics
- Minimally Invasive Surgery
Background:
- Percutaneous trigger thumb release is common in adults but not widely used in children.
- Trigger thumb in children can cause significant loss of thumb extension.
Purpose of the Study:
- To evaluate the efficacy and safety of percutaneous release (PR) for trigger thumb in the pediatric population.
- To compare PR with open release (OR) as a self-controlled study.
Main Methods:
- A prospective comparative study involving 15 pediatric patients (20 thumbs).
- Each patient underwent both PR and OR, serving as their own control.
- Thumb extension was measured pre- and post-procedure; A1 pulley release extent and iatrogenic injuries were assessed.
Main Results:
- PR improved thumb extension from -45.2° to -4° loss, while OR achieved 0° loss.
- Complete A1 pulley release occurred in only 20% of PR cases; 70% had 50-75% release.
- Flexor tendon lacerations were observed in 80% of cases, though no neurovascular injuries occurred.
Conclusions:
- Percutaneous release in pediatric trigger thumb is associated with a high rate of incomplete A1 pulley release.
- The risk of iatrogenic injury, particularly flexor tendon laceration, makes PR not recommended for children.
- Open release remains the preferred method for pediatric trigger thumb release.
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