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Percutaneous Trigger Thumb Release in Children: Neither Effective Nor Safe

Masquijo, Julio J. MD*; Ferreyra, Andres MD*; Lanfranchi, Lucas MD*; Torres-Gomez, Armando MD, MSc, FACS; Allende, Victoria MD*

Journal of Pediatric Orthopaedics: July/August 2014 - Volume 34 - Issue 5 - p 534–536
doi: 10.1097/BPO.0000000000000119
Upper Extremity

Background: Although percutaneous trigger thumb release has been extensively used in adults, the technique is not widespread in children. The purpose of this study was to evaluate the efficacy and safety of percutaneous trigger thumb release in the pediatric age group.

Methods: Twenty consecutive thumbs of 15 patients scheduled for surgical release of the A1 pulley were included in this cohort. Each patient received first the percutaneous release (PR) followed by an open release (OR) and served as self-controls. Thumb extension was assessed immediately before PR, after PR, and finally after OR, using a goniometer. Extent of the A1 pulley release, iatrogenic injury to the digital nerve and vessels, and flexor tendon laceration was assessed after PR. The distance between the PR and the digital nerve was measured in millimeters. Comparison between thumb extension after PR and OR was made using a paired t test.

Results: Preoperative range of motion averaged −45.2±21.7 degrees loss of extension (range, −80 to −10 degrees), decreased to −4±8 degrees loss of extension (range, −25 to 0 degrees) after PR, and to 0 degrees after OR. Clinically, release was complete in 14 cases (70%) and partial in 6 cases (30%). Once the thumb was approached, we confirmed that A1 pulley was completely cut in 4 cases (20%), to >75% in 2 cases (10%), and between 50% and 75% in the remaining 14 cases (70%). There were no neurovascular iatrogenic injuries. Mean distance between the needle and the digital nerve was 2.45±0.9 mm (range, 1 to 4 mm). Lacerations to the flexor tendons were observed in 80% of the cases.

Conclusions: We do not recommend PR in the pediatric thumb given the risk of neurovascular iatrogenic injury or incomplete A1 pulley release.

Level of Evidence: Level II therapeutic study—prospective comparative study.

*Department of Pediatric Orthopaedics, Sanatorio Allende, Córdoba, Argentina

ABC Medical Center, Mexico City, México

The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

The authors declare no conflicts of interest.

Reprints: Julio J. Masquijo, MD, Department of Pediatric Orthopaedics, Sanatorio Allende, H. Irigoyen 384, Nueva Córdoba CP5009, Argentina. E-mail:

© 2014 by Lippincott Williams & Wilkins