Surgical treatment of pediatric trigger thumb with metacarpophalangeal hyperextension laxity.

Between 1994 and 2004, seven patients (nine thumbs) at our institution were treated for trigger thumb with hyperextensible metacarpophalangeal (MP; >60°) anomaly with surgical release of the A1 pulley and proximal advancement of the MP volar plate. There were four girls and three boys (three right, two left, and two bilateral thumbs) with a mean age at surgery of 46 months (range, 26 to 82 months). The mean follow-up was 64 months (range, 1 to 8 years). At the time of the last follow-up, all patients had returned to full activities without functional limitations or pain and were satisfied with the outcome of the surgery. There was no recurrence of triggering or MP hyperextension deformity. The results from this study demonstrate that the trigger thumb in children with concomitant MP hyperextension laxity can be treated safely with predictable results by releasing the A1 pulley and advancing the volar plate.