Open Release of Pediatric Trigger Thumb.

Area of Science:

• Pediatric Orthopedics
• Hand Surgery
• Pediatric Surgery

Background:

• Trigger thumb in children, characterized by fixed interphalangeal (IP) joint flexion contractures, often requires intervention.
• Nonoperative treatments like watchful waiting, occupational therapy, and splinting have limited success rates.
• Failure of conservative management necessitates surgical correction to restore thumb function.

Purpose of the Study:

• To evaluate the efficacy and safety of open release of the A1 pulley for treating trigger thumb in children.
• To restore full interphalangeal (IP) joint extension and normal thumb motion.
• To provide a reliable surgical solution for cases unresponsive to nonoperative modalities.

Main Methods:

• Open surgical release of the A1 pulley, involving a transverse incision near the metacarpophalangeal (MP) flexion crease.
• Identification and release of the Notta nodule at the A1 pulley to allow flexor pollicis longus (FPL) tendon gliding.
• Intraoperative assessment of full passive IP joint extension and tendon integrity.
• Closure with absorbable sutures and use of local anesthetics for postoperative pain control.

Main Results:

• Open release achieves full range of motion in 95% of pediatric trigger thumb cases.
• Success rates significantly outperform nonoperative treatments (55% for therapy, 67% for splinting).
• The procedure demonstrates a low complication rate (approx. 3.4%) and minimal risk of recurrence when the A1 pulley is fully divided.

Conclusions:

• Open release of trigger thumb is a safe, reliable, and effective surgical treatment for children.
• It offers superior outcomes in restoring thumb motion compared to nonoperative management.
• The procedure allows for immediate resumption of activities with minimal postoperative rehabilitation.