Pediatric Trigger Thumb With Locked Interphalangeal Joint

S, Koh; Horii, Emiko; Hattori, Tatsuya; Hiroishi, Masayuki; Otsuka, Junko

doi:10.1097/bpo.0b013e318264484c

Cited by 30 publications

(35 citation statements)

References 12 publications

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“…The clinical outcomes for trigger thumb using splint therapy in five previously published reports [14][15][16][17][18] are presented in Table 2. The types and materials of splint as well as the wear time varied among these reports.…”

Section: Discussionmentioning

confidence: 99%

“…Surgical treatment offers excellent clinical results with few complications [1,4,[9][10][11][12][13]. Splint therapy provides good clinical results; reported improvement rates range from 71 to 92% [14][15][16][17][18]. The rate of spontaneous improvement is reported to range from 24 to 76% [9,10,12,[19][20][21].…”

Section: Introductionmentioning

confidence: 99%

“…In previous studies using splint therapy, splints employed different types, materials and devices for improving the extension loss of the IPJ of the thumb [14][15][16][17][18]. The splint therapy in this study consisted of a custom-made splint with coils that dynamically extended the thumb's IPJ.…”

Section: Introductionmentioning

confidence: 99%

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Clinical results of splinting versus observation for pediatric trigger thumb

Yano¹,

Ikeda

Yoneda³

et al. 2020

Journal of Pediatric Orthopaedics B

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Patients with pediatric trigger thumb present with fixed contracture of the interphalangeal joint (IPJ) or snapping of the thumb. We applied a hand-based dynamic splint using coils at the IPJ. The aim of this study was to report the clinical outcomes of splint therapy versus observation. One hundred twenty-nine thumbs (112 patients and 57 boys) were examined retrospectively. At initial presentation, parents selected the treatment after explanation of pathology and consents were obtained. Treatment was concluded when full extension or resolution of the involved IPJ was achieved; alternatively, surgical treatment was offered for patients who failed to improve. Improvement in extension loss to 0º and hyperextension was defined as resolution of the IPJ. Surgery was not selected as a first-line treatment strategy in any of the cases in this study. The rate of resolution was 59% at 31 months of follow-up in the splint group (99 thumbs) and 43% at 30 months in observation group (30 thumbs); there was no significant difference between the groups (P = 0.15). Twenty-one thumbs showed locking of the IPJ in the extended position during splint therapy, but all recovered with a 71% rate of resolution. The splint group showed a higher rate of resolution than the observation group; however, there was no significant difference between therapies. Our study showed that 55% of patients with pediatric trigger thumb showed resolution following conservative treatment for an average of 30 months until surgery could be performed under local anesthesia. Splint therapy and observation are viable treatment options prior to surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinical results of splinting versus observation for pediatric trigger thumb

Yano¹,

Ikeda

Yoneda³

et al. 2020

Journal of Pediatric Orthopaedics B

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“…Studies of splinting and stretching for pediatric trigger thumb have shown positive results 18,19 . Jung et al found that 80% of patients given a passive exercise protocol of passive extension of the thumb IP joint achieved IP joint extension to at least neutral at a mean follow-up of 63 months 18 .…”

Section: Pediatric Trigger Thumbmentioning

confidence: 99%

“…Jung et al found that 80% of patients given a passive exercise protocol of passive extension of the thumb IP joint achieved IP joint extension to at least neutral at a mean follow-up of 63 months 18 . Koh et al reported that 92% of locked trigger thumbs treated with splinting resolved by a mean of 22 months 19 .…”

Section: Pediatric Trigger Thumbmentioning

confidence: 99%

Congenital Disorders of the Pediatric Thumb

Nguyen

2022

JBJS Reviews

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» Surgical timing for pediatric trigger thumb treatment is controversial for numerous reasons including the potential for spontaneous resolution, the possibility of bilateral involvement, and anesthesia concerns regarding the developing brain. Hence, a reasonable approach is to delay the surgical procedure until the patient is ≥3 years of age.» Preaxial polydactyly is usually unilateral and sporadic, with the most common reconstruction method consisting of excision of the diminutive thumb with preservation and soft-tissue reconstruction of the dominant thumb. The surgical procedure is typically performed around the patient age of 1 year to decrease the risks of anesthesia but allow reconstruction prior to the development of a tip-to-tip pinch.» Triphalangeal thumb and thumb hypoplasia are often found in the setting of systemic anomalies such as Holt-Oram syndrome, thrombocytopenia absent radius syndrome, Fanconi anemia, VACTERL (vertebral anomalies, anal atresia, cardiac anomalies, tracheoesophageal fistula, renal defects, and limb anomalies), and/or Blackfan-Diamond anemia. As such, patients should receive adequate workup for these entities. A surgical procedure should be performed only once patients have been medically cleared.» The status of the carpometacarpal joint in thumb hypoplasia determines whether reconstruction with first web space deepening, collateral ligament stabilization, and opponensplasty compared with index pollicization is performed.

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