Efficacy Analysis of Day Surgery A1 Pulley Release for Pediatric Trigger Thumb

Yan Linhua,Jiang Linjun,Wu Jun,Liu Xing,Qu Xiangyang,Li Ming

doi:10.3389/fped.2021.734115

Abstract

Objective: To investigate clinical application of day surgery A1 pulley release for pediatric trigger thumb.Methods: We retrospectively analyzed the clinical data of 1,642 children with trigger thumb who were treated with day surgery A1 pulley release at our hospital, including satisfaction surveys, functional recovery, and complications.Results: The operative time for unilateral and bilateral tenolysis was 4.8 ± 3.1 and 9.2 ± 3.8 min, respectively. Three children had postoperative fever and were discharged on the 2nd day after surgery. The rest of the children were discharged on the day of surgery. All incisions healed primarily, and no complications of vascular and nerve injury were reported. The patients' degree of satisfaction with the medical treatment process, diagnosis and treatment workflow, treatment effectiveness, length of hospital stay and hospitalization cost, and discharge guidance were 97.9, 96.1, 99.3, 91.1, and 98.5%, respectively. The follow-up period was between 5 months and 3 years and 1 month. Four children experienced symptom relapse after the operation, and re-tenolysis was performed in one of them. At the final follow-up, the appearance and function of the thumb had recovered well in all cases.Conclusion: Day surgery A1 pulley release can effectively release tendon sheaths and has a short operative time, no complications of vascular and nerve injury, and good recovery of thumb function. It is a safe and reliable procedure with high patient satisfaction, and it is worthy of clinical promotion.

Highlights

Trigger thumb is a commonly encountered disease in pediatric practice, accounting for 87–93% of finger-stenosing tenosynovitis
The following principles apply to diseases indicated for pediatric day surgery: [1] The disease is common in children, the identical procedure is performed in a number of patients, and the operation can be implemented according to clinical pathway specifications; [2] the surgical technique is mature and minimally invasive, with a short operative time; and [3] the procedures are associated with mild postoperative pain, quick recovery, few complications, and no requirements for special care [20]
This study shows that as a procedure for the treatment of pediatric trigger thumb, A1 pulley release is appropriate for day surgery

Summary

Introduction

Trigger thumb is a commonly encountered disease in pediatric practice, accounting for 87–93% of finger-stenosing tenosynovitis. It is most common in children aged 1–4 years, with an incidence of 1–3% [1]. Non-surgical and surgical treatments for pediatric trigger thumbs are available [3, 4]. Non-surgical treatments include local hot compress, massage, medicine fumigation, and intrathecal injection of medicine [5]. The success rate of non-surgical treatment may vary, and the treatment duration is long [6]. Open A1 pulley release is currently considered to be a safe and effective treatment for pediatric trigger thumb [7]

Methods

Results

Discussion

Conclusion