Percutaneous A1 Pulley Release of Locked Trigger Thumb in Children

Kim,  Jong Pil; Kim,  Myung Ho; Yoo,  Moon Jib; Moon,  Sang Young; Yoon,  Sung Hyun

Journal of the Korean Society for Surgery of the Hand 2010;15(2):59-64.
Published online June 1, 2010.

Jong Pil Kim, Myung Ho Kim, Moon Jib Yoo, Sang Young Moon, Sung Hyun Yoon

Department of Orthopaedic Surgery, Dankook University College of Medicine, Cheonan, Korea. kimjp@dankook.ac.kr

Abstract

Purpose
To report the clinical outcomes of percutaneous A1 pulley release for the surgical treatment of locked trigger thumb in children. MATERIALS AND METHODS: Twenty-six trigger thumbs in 24 patients with a average of 14.2 months follow-up after percutaneous release were enrolled. There were 15 females and 9 males with an average age of 39 months. The mean time from first presentation to surgery was 16 months. Procedures were performed under local anesthesia. Postoperative examinations at immediate, 3 months and 1-year recorded pain, triggering and range of motion and presence of complications.

Results
All thumbs had a satisfactory result without digital nerve injury. Eleven patients(46%) had a mean 14.3degrees extension loss of the interphalangeal joint and 12.0degrees hyperextension of the metacarpophalangeal joint of the thumb, compared to the contralateral thumb. At final follow-up, all but 1 patient were completely resolved. The duration of symptoms and age were higher in the group with thumb deformity (p<0.05).

Conclusion
Temporary thumb deformity is possible after surgical treatment of trigger thumb in children with a long duration of symptoms. Percutaneous release can be a safe and satisfactory treatment option in pediatric trigger thumb.