Open surgery versus nonoperative treatments for paediatric trigger thumb: a systematic review

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.

Pediatric Trigger Thumb: Congenital or Developmental? A Unique Case Report

“…The incidence of pediatric trigger thumb is ~3.3 per 1,000 live births. 3 The existence of true congenital trigger thumb has been questioned by many authors in the past. [4][5][6][7] Dinham and Meggit performed the study which reported 19 patients of congenital trigger thumb detected at birth among 105 patients in their series way back in 1974.…”

Pediatric Trigger Digits

“…The authors found full IP joint motion reported in 95% of patients treated surgically, 67% treated with orthoses, and 55% treated with exercise, and concluded that open surgery yields the most reliable outcomes. 26 A recent large retrospective review of 173 consecutive patients treated with surgical release of trigger thumb demonstrated full extension in all thumbs with IP joint hyperextension in 6, no recurrences, and no digital nerve injuries. 27 A total of 79 families returned questionnaires at an average of 4 years after their children's surgery.…”

Trigger Thumb in Children

“…Daljnja istraživanja trebala bi više pozornosti usmjeriti na različite vrste udlaga koje se rabe, precizno definiranje nošenja tijekom dana i noći te na interval primjene do postizanja oporavka, i za još fleksibilne palce i za one s razvijenom fleksijskom kontrakturom. 38 Watanabe i sur. zabilježili su poboljšanje u 86% djece liječene samo vježbanjem.…”

“…26 Farr i sur. 38 dali su sustavni pregled ishoda škljocavog palca iz 17 retrospektivnih studija i jedne prospektivne. Puni opseg pokreta postignut je u 95% pacijenata liječenih kirurški, u 67% onih koji su nosili udlagu i u 55% tretiranih pasivnim vježbama istezanja.…”