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Open surgery versus nonoperative treatments for paediatric trigger thumb: a systematic review
1Department of Pediatric Orthopaedics, Deformity Correction and Adult Foot & Ankle Surgery, Orthopaedic Hospital Vienna, Speising, Austria sebastian.farr@oss.at.
Insights
Open surgery for paediatric trigger thumb reliably restores interphalangeal (IP) joint motion in 95% of children. Nonoperative treatments like splinting and exercising show lower success rates for this condition.
Area of Science:
- Orthopedics
- Pediatric Surgery
- Rehabilitation Medicine
Background:
- Paediatric trigger thumb is a common condition affecting the interphalangeal (IP) joint.
- Treatment options include open surgical release, splinting, and passive exercising.
- Evidence on the comparative effectiveness of these treatments is limited.
Purpose of the Study:
- To systematically review and compare the outcomes of different treatment modalities for paediatric trigger thumb.
- To evaluate the effectiveness of open surgery, splinting, and passive exercising on interphalangeal joint motion.
Main Methods:
- Systematic review of seven major databases.
- Inclusion of studies with a minimum 12-month follow-up.
- Analysis of data from 17 retrospective and 1 prospective study, encompassing 634 children for surgery, 115 for splinting, and 89 for exercising.
Main Results:
- Open surgery achieved full IP joint motion in 95% of cases.
- Continuous splinting resulted in full motion in 67% of children.
- Passive exercising achieved full motion in 55% of children.
Conclusions:
- Open surgical release appears to be the most effective treatment for paediatric trigger thumb, yielding reliable and rapid outcomes.
- Nonoperative treatments demonstrate lower success rates compared to surgery.
- Further high-quality research is needed due to the low level of evidence currently available.
Abstract:
The purpose of this systematic review was to determine the outcome of interphalangeal (IP) joint motion in children undergoing open surgical release, splinting, and passive exercising therapy for the treatment of paediatric trigger thumb. We conducted an online literature search of seven major databases. Only studies with a mean follow-up of at least 12 months were considered for inclusion. Seventeen retrospective studies and one prospective study met all the inclusion criteria. They reported on the results of surgery (634 children, 759 thumbs), splinting (115 children, 138 thumbs), and passive exercising (89 children, 108 thumbs). The mean follow-up periods were 59 (surgery), 23 (splinting), and 76 months (exercising), respectively. Full IP joint motion without residual triggering was achieved in 95% of all children undergoing surgery, in 67% of children treated with continuous splinting, and 55% after passive exercising. Based on the low level of evidence available, it seems that open surgery resulted in more reliable and rapid outcomes compared with nonoperative treatment.
