Retrospective study of open versus percutaneous surgery for trigger thumb in children.
BACKGROUND
Percutaneous release for trigger finger in adults is well established, but this is not so for trigger thumb in children. The traditional treatment for trigger thumbs in children, if conservative treatment has failed, is open surgery. The authors' aim is to recommend that percutaneous release may be more appropriate in the treatment of trigger thumb in children.


METHODS
The authors performed a retrospective study of open versus percutaneous release for trigger thumb in children with a mean age of 2.4 years from December of 1984 to March of 2003. The 61 patients with 72 trigger thumbs included 35 boys and 26 girls. Thirty-two trigger thumbs were treated using open surgery before February of 1989. More recently, 40 trigger thumbs were treated using percutaneous surgery. The authors recommended a new manipulation to examine whether the A1 pulley had completely released, while the sensitive patients were operated on under general anesthesia.


RESULTS
The percutaneous procedure yielded up to a 90 percent successful release of trigger thumb in children without recurrence. The outcome of releasing trigger thumbs using these two surgical techniques showed no statistically significant difference. Thirty-seven trigger thumbs treated with percutaneous re-lease were able to achieve full extension and flexion without any residual deformity.


CONCLUSIONS
The authors developed a special manipulation to ensure complete release of the A1 pulley when general anesthesia is necessary in the cases of sensitive children and parents. The results suggest that percutaneous release for trigger thumb in children is a satisfactory alternative to open release.
Wang
Hsien-Chung
HC
Department of Orthopedic Surgery, Chung-Ho Memorial Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Lin
Gau-Tyan
GT
D000768:Anesthesia, General; D000772:Anesthesia, Local; D002648:Child; D002675:Child, Preschool; D003286:Contracture / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D019637:Orthopedic Procedures / Q000379:methods*; D012189:Retrospective Studies; D013710:Tendons / Q000601:surgery*; D013717:Tenosynovitis / Q000601:surgery*; D013933:Thumb / Q000601:surgery*; D016896:Treatment Outcome