Steroid Injection and Open Trigger Finger Release Outcomes: A Retrospective Review of 999 Digits

Abstract

Background: Open surgical release of the A1 pulley is the definitive treatment for the common hand condition of trigger finger, or inflammatory stenosing tenosynovitis. Anecdotal evidence among hand surgeons has questioned whether or not recent steroid injection may be related to complications following open trigger finger release, particularly wound infection, but no studies have primarily studied this connection to date. We aimed to determine whether recent steroid injection was associated with postoperative surgical infections. Methods: We performed a retrospective chart review of 780 adult patients who had undergone open trigger finger release of 999 digits by 6 fellowship-trained hand surgeons at three affiliated hospital settings from January 1, 2014, to January 1, 2016. Data on timing of steroid injections relative to surgery, number of steroid injections, concomitant conditions, use of antibiotics, and postoperative complications including infections were gathered. Results: Steroid injection timing relative to subsequent operative intervention correlated with postoperative surgical site infection in trigger finger release. Older age and decreasing days between steroid injection and surgery correlated with infection rates. Other factors found to be associated with infection rates included smoking, use of preoperative antibiotics, and use of lidocaine with epinephrine. The other factors examined did not correlate with infection rates. Conclusions: Steroid injection, smoking, increasing age, lesser number of days between steroid injection and surgery, and use of lidocaine with epinephrine are risk factors for postoperative trigger surgical infections. We recommend careful preoperative counseling regarding higher wound healing risks for smokers, avoidance of steroid injections immediately prior to an operative date, and scheduling operative dates that tend to be greater than 80 days from the date of last steroid injection. We also recommend avoidance of epinephrine in the local anesthetic solution, as this may minimize surgical site infection risks.

Comparison of Safety and Insurance Payments for Minor Hand Procedures Across Operative Settings

“…Complications were determined by the literature review and included infection, stiffness, nerve laceration, hematoma, and complex regional pain syndrome (eTable 1 in the Supplement provides ICD-9 and ICD-10 diagnosis codes). 9 , 10 , 11 , 12 Moreover, we collected reoperation rates for treatment of infection, hematoma, or nerve injury (eTable 1 and eTable 2 in the Supplement ) during the 90-day postoperative period. Encounters were collected if they had a relevant diagnosis and procedure code.…”

A cadaveric assessment of percutaneous trigger finger release with 15° stab knife: its effectiveness and complications

“…This finding is more or less in line with other available studies. Success rates of finger release have been demonstrated in the observational range from 84 to 100% by mid-term follow-up [ 17 – 19 ]. Studies demonstrated effective findings using different materials in a percutaneous release such as knives, scalpels, and use of ultrasound [ 24 – 27 ].…”

“…There are studies that indicated a lower success rate of conservative treatment including steroid injection in diabetic patients, splinting, and other non-operative modalities [ 15 , 16 ], while percutaneous release has been introduced as a safe alternative, where conservative treatment fails because trigger digit was found to be effectively managed by percutaneous release [ 15 ]. Success rates of finger release have been reported to be between 84 and 100% by the mid-term follow-up [ 17 – 19 ].…”

Complications of Percutaneous Release of the Trigger Finger

“…Treatment of trigger finger usually is conservative if it is uncomplicated and if it has a short history of symptoms. It includes steroid injections and splinting [2,3,4]. Percutaneous trigger finger release is simple and effective with success rates of 84% to 100% at the mid-term follow-up [4,5,6].…”

“…It includes steroid injections and splinting [2,3,4]. Percutaneous trigger finger release is simple and effective with success rates of 84% to 100% at the mid-term follow-up [4,5,6]. In trigger finger surgery, exposure of the A1 pulley after mini-incision and then its longitudinal excision to release the tendon is the most prevalently known method.…”