The Effect of Corticosteroid Injections on Postoperative Infections in Trigger Finger Release

Abstract

Background Corticosteroid injections have proven benefit in the treatment of symptomatic trigger finger; however, the immune system and tissue repair modulating properties of corticosteroids justify further consideration in surgical candidates. The aim of this study was to assess the relationship between corticosteroid injections and postoperative infection in trigger finger release. Methods A single-center retrospective review was conducted of patients seen from 2010 to 2019 to identify those who underwent trigger finger release with subsequent antibiotic prescription for chart-documented wound infection. A demographic matched cohort of 100 patients was identified for comparison. Preoperative corticosteroid injection history including timing, frequency, and dose was collected for all patients. Patient demographics, comorbidities, and presence of postoperative infection were collected from patient medical records. Superficial infection was defined as those requiring antibiotics for resolution without return to the operating room; deep infection was defined as infections that required irrigation and debridement. Results Of 3234 patients who underwent trigger finger release, 58 (1.8%) were identified with postoperative infections, 6 (0.2%) of which were deep infections. History of corticosteroid injection was significantly more common in patients with postoperative infection. Compared with an age-matched, gender-matched, and body mass index–matched cohort, patients with postoperative infection had significantly increased rate of diabetes mellitus at 34.5% to 19% ( P = .04) Conclusions While corticosteroid injection in the preoperative period is associated with a higher rate of postoperative infection, the time before surgery and the corticosteroid dose do not appear to have an effect.

Hand and Upper Extremity Surgical Site Infection Rates Associated With Perioperative Corticosteroid Injection: A Review of the Literature

“…The authors showed that the timing of CSI before surgery did not increase the risk of postoperative infection in open trigger finger release. 18 Postoperative infection was defined by the corresponding ICD-9 and ICD-10 codes, patients who had antibiotics in the postoperative period, and patients who had infection as documented in their chart by the operating surgeon; DIs were defined as infections needing either irrigation or surgical debirdement. 18 In another study, Straszewski et al 19 showed an association between open trigger finger release and DI when CSI was given in less than 1 month preoperatively.…”

“…Several studies looked at CSI and trigger finger release. 3,6,15,18,19 In the study by Ng et al 6 on preoperative steroid injection and open trigger finger release outcomes, the mean number of days between injection and surgery for those who had an infection was 79 days compared with those who did not have a surgical infection, with a mean of 260 days. The study was based in 3 hospitals and 6 fellowship-trained orthopedic surgeons.…”

“…30 Glucocorticoid posttranscriptional effects primarily modulated inflammation, but CSI of the hand and wrist may also transiently increase blood serum glucose in patients with diabetes between 1 and 5 days after injection. [31][32][33] Diabetes independently increases the risk of SSI 18 and developing De Quervain tendonitis, trigger finger, and carpal tunnel syndrome, conditions commonly treated by corticosteroids. 32 Glucocorticoid has opposite actions to insulin as it prevents glucose uptake from peripheral tissues and promotes glucose release from the liver by enhancing gluconeogenesis, explaining the transient glucose elevation.…”

“…Three studies reported using triamcinolone 40 mg (hand and elbow) and 2 studies reported using methylprednisolone (shoulder arthroplasty). 6,7,13,21,25 The studies by Kirby et al 17,18 used dexamethasone (CTR and open trigger finger release).…”

Wrist & Hand

“…Corticosteroid injections have been associated in the literature with subsequent surgical infections in procedures such as knee and shoulder surgery, and this group from New York (New York, USA) set out to examine if the same is true for trigger finger release. 8 They conducted a single-centre retrospective review of cases over a nine-year period in which the patient underwent a surgical release, but also had a subsequent prescription of antibiotics for a documented surgical wound infection. The administration of a preoperative corticosteroid injection was recorded for all patients, including timing, number of injections, and dose administered.…”