Letter Regarding “Adverse Events of Open A1 Pulley Release for Idiopathic Trigger Finger”

Abstract

It was with great interest that we read Bruijnzeel et al's article “Adverse Events of Open A1 Pulley Release for Idiopathic Trigger Finger” in your journal.1Bruijnzeel H. Neuhaus V. Fostvedt S. Jupiter J.B. Mudgal C.S. Ring D.C. Adverse events of open A1 pulley release for idiopathic trigger finger.J Hand Surg. 2012; 37A: 1650-1656Google Scholar In this large retrospective, the authors found interesting data, especially regarding trigger finger and diabetic disease. The number of patients was impressive, and the authors did a great job. However, the authors stated that about 1 in 20 fingers experienced a mild, transient adverse event (most commonly pain or stiffness) after surgical release of the A1 pulley for idiopathic trigger finger and that about 1 in 200 had a second surgery.1Bruijnzeel H. Neuhaus V. Fostvedt S. Jupiter J.B. Mudgal C.S. Ring D.C. Adverse events of open A1 pulley release for idiopathic trigger finger.J Hand Surg. 2012; 37A: 1650-1656Google Scholar The adverse events were defined as follows: “(1) wound problems (surgical site infection, suture-related problems such as suture abscess and suture infection, and other wound issues), (2) inadequate treatment (postoperative persistence or recurrence), and (3) recovery issues (postoperative nontriggering symptoms treated with steroid injection or slow recovery of motion treated with hand therapy).”1Bruijnzeel H. Neuhaus V. Fostvedt S. Jupiter J.B. Mudgal C.S. Ring D.C. Adverse events of open A1 pulley release for idiopathic trigger finger.J Hand Surg. 2012; 37A: 1650-1656Google Scholar The mean follow-up was 41 days (range, 5–1,718 d). No standard deviation was given. Recently, we performed a study on the same topic; however, only 103 patients (117 trigger fingers) were included in this study (2 patients were lost to follow up [2%]).2Cakmak F. Wolf M.B. Bruckner T. Hahn P. Unglaub F. Follow-up investigation of open trigger digit release.Arch Orthop Trauma Surg. 2012; 132: 685-691Crossref PubMed Scopus (27) Google Scholar We observed patients after open A1 pulley release until complete they had resolution of all problems. Sixty patients (59%) were free of reported problems and were satisfied with the procedure's result after 4 weeks. However, 35 patients detected light swelling and 15 patients reported light pain surrounding the surgical approach. Twenty-four patients experienced scar tenderness. Ten patients commented on painful movement of the operated digit. Twenty-two patients showed limitation of motion 4 weeks postoperatively.2Cakmak F. Wolf M.B. Bruckner T. Hahn P. Unglaub F. Follow-up investigation of open trigger digit release.Arch Orthop Trauma Surg. 2012; 132: 685-691Crossref PubMed Scopus (27) Google Scholar Figure 1 shows the number of patients with postoperative symptoms in relation to the duration in months. Our study showed that all patients require good postoperative follow-up with the option of further treatment alternatives (hand therapy, pain medication, steroid injections, and silicone sheet treatment) for those still experiencing symptoms. In our experience, surgical trigger finger release is underestimated. “A mild, transient adverse event in 1 in 20 fingers” without a standardized clinical examination should be interpreted with caution. Adverse Events of Open A1 Pulley Release for Idiopathic Trigger FingerJournal of Hand SurgeryVol. 37Issue 8PreviewTo classify and report adverse events of trigger finger release in a large cohort of patients. Full-Text PDF In ReplyJournal of Hand SurgeryVol. 37Issue 11PreviewWe are happy to reinforce the idea that surgery should not be taken lightly—even a trigger release, which is arguably 1 of the simplest and smallest surgeries in any field. On the other hand, our motivation for doing this study was the fact that studies of small series of patients report more minor and major complications than are consistent with our experience. Our concern is that surgeons with a few bad outcomes might decide to publish a small subset of their experience that is neither internally nor externally valid. Full-Text PDF