Comparison of open and percutaneous A1 pulley release in pediatric trigger thumb: a retrospective cohort study

TL;DR

This study compares two surgical methods for treating pediatric trigger thumb and finds both to be safe and effective, with open surgery having slightly better outcomes.

Contribution

A retrospective comparison of open and percutaneous A1 pulley release techniques for pediatric trigger thumb.

Findings

Open release achieved 100% satisfactory results compared to 85.7% for percutaneous release.

Both techniques had low recurrence rates and no major complications.

Superficial infections occurred only in the open group.

Abstract

Pediatric trigger thumb (PTT) is characterized by flexion deformity and interphalangeal joint locking caused by A1 pulley constriction. Open A1 pulley release is the standard surgical method, whereas percutaneous release under local anesthesia offers a minimally invasive outpatient alternative. This study compared the outcomes of these two techniques.

A retrospective cohort of children aged 2–10 years undergoing A1 pulley release between 2012 and 2024 was analyzed. Patients were assigned to open release under general anesthesia or percutaneous release under local anesthesia. Demographics, operative details, complications, and outcomes were compared using appropriate statistical tests, with significance set at p<0.05.

Ninety-nine patients (107 thumbs) were included: 53 (58 thumbs) in the open group and 46 (49 thumbs) in the percutaneous group. Mean age at surgery was similar (4.33 ± 1.53 vs. 4.29 ± 1.70 years; p=0.781). Satisfactory results were achieved in 100 % of open and 85.7 % of percutaneous cases (p=0.003). Recurrence was 3.4 % and 8.2 %, respectively (p=0.409). No neurovascular or tendon injuries occurred; superficial infections were minor and limited to the open group.

Both techniques are effective and safe. Open release remains the gold standard, while percutaneous release is a practical minimally invasive option in selected patients.

III, retrospective comparative study.

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