Percutaneous release for trigger thumb in children under local anesthesia

Abstract

Trigger thumb surgery can be performed through open surgery or percutaneous release. Open surgery often requires hospitalization, an operating room, a surgical incision, and postoperative wound care; however, percutaneous release does not require hospitalization or surgery, and is relatively easier and faster. We aimed to assess the results of percutaneous A-1 pulley release using local anesthesia without hospitalization for the treatment of pediatric trigger thumb. In this retrospective study, we included patients operated on between March 2013 and August 2020 with the diagnosis of trigger thumb. The percutaneous release under local anesthesia was applied to all the children by one orthopedic surgeon. All percutaneous release procedures were performed in outpatient clinic conditions. There were 183 children (218 thumbs) who were enrolled in the clinic. Eighty-seven patients were male (47.5%) and 96 were female (52.5%). The average follow-up duration was 5 years (1–8.5 years). Among the 218 trigger thumb cases, 211 were satisfactory (successful result rate 96.8%). Relapse was seen in only 3 thumbs in the early postoperative period. No patient experienced neurovascular deficit or infection. The percutaneous surgical release in pediatric trigger thumb treatment is a simple, minimally invasive procedure that can be done in an outpatient setting under local anesthesia. In addition, the procedure duration is short and has minimal complication rates and maximum patient satisfaction. Level of Evidence III.

Letter to the editor, concerning Cimen et al.: ‘Percutaneous release for trigger thumb in children under local anesthesia’

“…Although a few small series did not report neurovascular complications with the percutaneous technique, we concur with Shah and Bae [9] that these small series might lack statistical power. Cimen et al [1] presented a larger case series; however, their method for evaluating finger sensation lacks clarity and might be prone to bias, as assessments were performed without validated scales. The authors utilized a fine needle to penetrate the distal ulnar and radial sides of the affected thumb while the child was asleep.…”

“…We read the article titled ‘Percutaneous Release for Trigger Thumb in Children under Local Anesthesia’ [1] with great interest. We appreciate the authors’ efforts to explore treatment alternatives to the gold standard, which is open surgery in pediatric trigger thumb.…”

“…Cimen et al . [1] presented a larger case series; however, their method for evaluating finger sensation lacks clarity and might be prone to bias, as assessments were performed without validated scales. The authors utilized a fine needle to penetrate the distal ulnar and radial sides of the affected thumb while the child was asleep.…”