EFFICACY OF THE PERCUTANEOUS TECHNIQUE FOR TREATMENT OF PEDIATRIC TRIGGER FINGER

Abstract

Introduction and Objectives: Release of the A1 pulley in trigger finger can be done by an open method or by a percutaneous technique using an intramuscular needle. The percutaneous technique results in resolution of trigger finger. However, a higher recurrence rate has been reported in adults as compared to the conventional open technique. To our knowledge no one has shown the efficacy of the percutaneous technique for release of the A1 pulley in children. For this reason, we have decided to study the efficacy and safety of the procedure.

Materials and Methods: Since November 2002, two senior surgeons from the paediatric orthopaedic unit have treated 10 patients with trigger finger using the percutaneous technique. Study subjects were not selected. Rather, the study included the first 10 cases of fingers with this condition that presented for medical consultation. In all cases, the operation consisted of two surgical stages. The first stage consisted of percutaneous cutting of the pulley using the bevel of an intramuscular needle. The second stage immediately following involved open examination of the pulley, tendon, and adjacent neurovascular structures.

Results: In the first surgical stage (percutaneous surgery) we were able to resolve clinical locking or tendinous nodules in all cases. In the second surgical stage (surgical examination), we observed the following: incomplete release of the pulley in 70% of cases, one case of flexor tendon laceration, and one case of minor lacerations of the neurovascular bundle. The condition did not recur in any of the patients.

Discussion and Conclusions: In our hands, percutaneous surgery provides less control over release of the pulley and less control over possible iatrogenic damage to adjacent structures and does not allow us to forgo the use of general anaesthesia.