gms | German Medical Science

14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Failure of Percutaneous A1 pulley release in Trigger Digits

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  • presenting/speaker Neunghan Jeon - Samsung Medical Center, Seoul, South Korea
  • Min Jong Park - Samsung Medical Center, Seoul, South Korea
  • Jae Woo Shim - Samsung Medical Center, Seoul, South Korea
  • Hyun Jun Kim - Samsung Medical Center, Seoul, South Korea

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-1147

doi: 10.3205/19ifssh0909, urn:nbn:de:0183-19ifssh09093

Published: February 6, 2020

© 2020 Jeon et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objectives/Interrogation: The purpose of this study is to identify the risk factors that contribute to persistent symptoms after the percutaneous release, thus requiring further treatment such as triamcinolone (TA) injection or open surgery.

Methods: 341 digits (256 patients) of percutaneous A1 pulley release were performed from December 2014 to August 2017 by a senior surgeon at a single center. We excluded 19 patients (25 digits) whose record of underlying medical condition was not available at this center. We conducted a retrospective study on the remaining 316 digits.

Results and Conclusions: During the period, no serious complication (e.g. infection, tendon rupture) was reported, and 2 cases of incomplete release were observed.

41 digits (12.9%) needed additional TA injection to relieve remaining symptoms. 8 digits (2.5%) required open surgery due to persisting symptoms even after TA injection. We had to perform A2 pulley partial release in 5 patients. Tenosynovectomy was performed on 7 patients. During open surgery, FDS thickening was observed in 2 patients, fibrotic tissue formation in 3, and adhesion in 1.

Of the failure cases of percutaneous release, the middle finger was the most common (40.2%), and the thumb came up second (24.1%). However, the thumb was the least likely to receive further treatments after percutaneous release (5.3%).

The percentage of additional procedures done was higher in male patients (18.2%, 14 out of 77 digits) than in female patients (14.6%, 35 out of 239 digits). Age showed a negative correlation with the likelihood of receiving further treatment (30.8% in age group 30-40, 14.2% in 50-60, 14.1% in 70-80). But these were not statistically significant. (gender, p=0.456: age, P=0.144).

We investigated whether DM and rheumatoid diseases, both known to affect the connective tissue, were relevant risk factors, but the results were not significant. (DM, P=0.107: Rheumatoid disease, P=0.313).

Most cases which needed additional treatment after percutaneous release of trigger digits had refractory inflammation. Although not statistically proven, male and younger age patients tend to have higher possibility of additional treatments.