Pediatric trigger thumb with locked interphalangeal joint: can observation or splinting be a treatment option?

BACKGROUND

The purpose of this study is to report the natural history of pediatric trigger thumb with locked interphalangeal joint, the efficacy of a splint for this condition, and the outcome of late surgery.

METHODS

Medical records of 64 patients were retrospectively reviewed. Patients were treated with a coil splint when parents and patients accepted; otherwise, regular observation was conducted. Splint application and/or observation were terminated either when the patient gained full range of active motion without snapping, or underwent surgical intervention.

RESULTS

In splint group, 92% of the patients experienced complete symptom relief in 22 months, whereas 60% resolved completely in 59 months in observation group. The differences were statistically significant. One thumb in a patient with bilateral involvement remained locked while the other completely resolved. The rest of the patients also showed improved symptom from locking to snapping. Four patients with residual snapping underwent surgery at the age of 8 years and above without any deformity and complication.

CONCLUSIONS

Splint was efficient in shortening the time for symptom relief; however, the natural history revealed the self-limiting nature of this condition. Late surgery was safe and effective for residual snapping and can be presented as one treatment option to the patients and families, combined with conservative treatment.

LEVEL OF EVIDENCE

Level III--retrospective comparative study.