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

OBJECTIVES

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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

LEVEL OF EVIDENCE: III, retrospective comparative study.