Efficacy Analysis of Day Surgery A1 Pulley Release for Pediatric Trigger Thumb

Abstract

Objective: To investigate clinical application of day surgery A1 pulley release for pediatric trigger thumb.Methods: We retrospectively analyzed the clinical data of 1,642 children with trigger thumb who were treated with day surgery A1 pulley release at our hospital, including satisfaction surveys, functional recovery, and complications.Results: The operative time for unilateral and bilateral tenolysis was 4.8 ± 3.1 and 9.2 ± 3.8 min, respectively. Three children had postoperative fever and were discharged on the 2nd day after surgery. The rest of the children were discharged on the day of surgery. All incisions healed primarily, and no complications of vascular and nerve injury were reported. The patients' degree of satisfaction with the medical treatment process, diagnosis and treatment workflow, treatment effectiveness, length of hospital stay and hospitalization cost, and discharge guidance were 97.9, 96.1, 99.3, 91.1, and 98.5%, respectively. The follow-up period was between 5 months and 3 years and 1 month. Four children experienced symptom relapse after the operation, and re-tenolysis was performed in one of them. At the final follow-up, the appearance and function of the thumb had recovered well in all cases.Conclusion: Day surgery A1 pulley release can effectively release tendon sheaths and has a short operative time, no complications of vascular and nerve injury, and good recovery of thumb function. It is a safe and reliable procedure with high patient satisfaction, and it is worthy of clinical promotion.

Trigger thumb treatment approach: Results of a survey of EPOS members

“…Although associated with better results, open surgical treatment is not exempt from few complications such as incomplete release, wound complications, bowstringing, nerve injury, IP flexion deficit, and metacarpophalangeal joint hyperextension. 13,34,35 Dittmer et al 9 in his article reported a complication rate of 3.4% with a recurrence and superficial infection rate of 1.7% each while Linhua et al 15 in his study analyzing 1930 operated thumbs reported a complication rate of 0.2% referring to 1 patient who needed to be re-operated on due to trigger recurrence. As in the literature, the most frequently reported complications in our study were recurrence/ incomplete division (59%) and superficial wound infection (30%).…”

“…[5][6][7] There is no consensus on the therapeutic approach to this condition, and the literature often includes several different options and strategies with good outcomes, including mere observation without intervention, conservative treatment (exercises and/or splints), or surgical treatment (open or percutaneous). 1,[8][9][10][11][12][13][14][15][16][17] The aim of this study is to analyze the clinical reality of trigger thumb treatment in the pediatric population among members of the European Paediatric Orthopaedic Society (EPOS), focusing on surgeon's profile and experience and trigger thumb diagnostic and treatment approaches.…”

Younger Age and Left Side Are Risk Factors for Contralateral Trigger Thumb in Children

“…TT treatment is simple but remains controversial. [18][19][20] The metachronism of bilateral TT may lead to additional surgery under anesthesia, which poses a dilemma for the surgeon. Knowledge of the temporal development of bilateral TT may be useful for preventing a second surgery and providing evidence for clinical practice.…”

“…TT treatment is simple but remains controversial 18–20. The metachronism of bilateral TT may lead to additional surgery under anesthesia, which poses a dilemma for the surgeon.…”

Trigger Thumb, Trigger Finger and Clasped Thumb

“…Regarding the treatment of trigger thumb, there is no consensus on the initial approach, the therapeutic options or the best time for treatment [ 25 ]. Treatment options range from observation (no intervention) to conservative treatment (exercise and/or splints) and to surgical treatment (open or percutaneous) [ 1 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ]. It is recognized that many cases resolve spontaneously, although the results in the literature vary even when considering similar follow-up times [ 1 , 26 ].…”