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Pediatric Trigger Thumb with Metacarpophalangeal Joint Hyperextension or Instability
Sheng Jin1, Kaiying Shen1, Yunlan Xu1
1Department of Pediatric Orthopedics, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China (mainland).
Insights
Pediatric trigger thumb can involve metacarpophalangeal joint hyperextension (MCPH) or instability (MCPI). Cast treatment alone for MCPH showed persistence, while combined cast and brace treatment for MCPI demonstrated good recovery rates.
Area of Science:
- Orthopedics
- Pediatric Surgery
- Hand Surgery
Background:
- Pediatric trigger thumb can coexist with metacarpophalangeal joint hyperextension (MCPH) or instability (MCPI).
- Understanding the mechanism and treatment of these combined conditions is crucial for pediatric hand care.
Purpose of the Study:
- To report on the mechanism and treatment of MCPH or MCPI in pediatric trigger thumb.
- To compare treatment outcomes between MCPH and MCPI groups.
Main Methods:
- 1083 children with trigger thumb surgery were analyzed.
- Patients were divided into MCPH and MCPI groups based on metacarpophalangeal joint extension.
- MCPH group received cast treatment; MCPI group received cast and brace treatment post-surgery.
Main Results:
- 154 cases (185 thumbs) presented with trigger thumb and MCPH or MCPI.
- MCPH persisted after cast removal in the MCPH group.
- In the MCPI group, 12 of 18 thumbs recovered, with 6 relapses after brace removal.
Conclusions:
- Pediatric trigger thumb with MCPH/MCPI is linked to multi-joint laxity.
- MCPH may not require further treatment post-cast if it persists short-term.
- Cast and brace treatment is effective for MCPI in pediatric trigger thumb.
Abstract:
BACKGROUND The aim of this study was to provide the first on report on the mechanism and the different treatment measures of metacarpophalangeal joint hyperextension (MCPH) or metacarpophalangeal joint instability (MCPI) in cases of pediatric trigger thumb. Some pediatric trigger thumb patients have disease combined with excessive extension of metacarpophalangeal (MCP) joint or instability of MCP joint. MATERIAL AND METHODS A total of 1083 children with trigger thumb surgery were divided into 2 groups (the MCPH group and the MCPI group) by the extension degree of the MCP joint. After tendon sheath released, the MCPH group was treated by a cast and the MCPI group was treated by a cast and a brace. We compared the differences in baseline data and the further functional activities of interphalangeal (IP) and MCP joint between the 2 groups. RESULTS Among the 1083 cases, 154 cases (185 thumbs) were trigger thumb with MCPH or MCPI, of which 167 thumbs were placed in the MCPH group and 18 thumbs were placed in the MCPI group. The average age of the MCPH group was 2.8 years, with an average duration of disease of 13 months. The average age of the MCPI group was 6.6 years, with an average duration of disease of 33 months. MCPH still existed after cast removal. In the MCPI group, 12 out of 18 thumbs recovered; 6 thumbs relapsed at 2-4 months after brace removal. CONCLUSIONS Trigger thumb with MCPH and MCPI in children is significantly associated with multi-joint laxity. While there was still MCPH after cast treatment, there was no need for further treatment during the short-term follow-up. Cast and brace treatment after surgery was a simple, easy method for treatment of MCPI and had a good effect.
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