Trigger Thumb in Pediatric Patients: A 20-Year Update

Abstract

Background: The study purpose was to analyze the characteristics of patients presenting for evaluation of pediatric trigger thumb over a 20-year period and to determine what factors were associated with operative versus nonoperative management. Methods: All patients evaluated for a pediatric trigger thumb by 1 of 2 hand surgeons at our institution between January 1, 2000, and August 31, 2021, were retrospectively reviewed. Data were collected, including patient demographics, laterality, patient age and stage of triggering at presentation, treatment recommendations, age at surgery (if performed), and complications. Comparison was made based on age group (<2 years, 2-5 years, and >5 years). Subgroup analysis was performed for patients who had alternative treatments recommended prior to surgery. Results: A total of 381 patients (468 thumbs) were identified. The average age at presentation was 3.1 years, 76% were stage IV locked trigger thumbs, and 78% underwent surgery. Patients below 2 years were more likely to have bilateral involvement and have nonoperative management recommended prior to surgery. Those below 5 years were more likely to present with stage IV triggering. Patients who presented with a stage IV trigger thumb and had an initial alternative treatment were more likely to go on to have surgery. The total complication rate was 5.3%. Conclusions: These findings are helpful in counseling families and better understanding this patient population. We recommend early surgical intervention, rather than observation or splinting, for patients with stage IV trigger thumbs who can safely undergo anesthesia.