MacConnell Ashley E, Schoenfeldt Theodore L, Bowman Christine A, January Alicia M, Fishman Felicity G
Loyola University Medical Center, Maywood, IL, USA.
Shriners Children's Chicago, Chicago, IL, USA.
Hand (N Y). 2025 Mar;20(2):213-217. doi: 10.1177/15589447231210925. Epub 2023 Nov 28.
The appropriate initial management of pediatric trigger thumb (PTT) remains controversial. Some providers advocate for prolonged nonoperative management, whereas others may offer surgical release to provide a reliable and expedient resolution. The goal of this study was to elucidate the practice patterns of surgeons with different fellowship training who treat patients with PTT. We hypothesized that an association between surgeon specialty training and treatment algorithm would be identified.
A cross-sectional survey was sent to mailing lists of 3 professional organizations whose members represent most providers caring for pediatric hand patients. Respondents were asked their training background and treatment recommendations for several clinical scenarios. Responses were compared across subspecialties.
Of the respondents, 444 completed a fellowship in hand surgery, 167 completed a pediatric orthopedic fellowship, and 155 completed an additional congenital hand fellowship. Providers with hand fellowship training were more likely to offer surgical intervention as a first-line treatment for a 3-year-old patient with a flexible trigger thumb than those who completed a pediatric orthopedic fellowship ( = .001), and more likely to offer surgical intervention to a 3-year-old patient with an intermittent ( = .007), painful ( = .015), or locked ( = .012) trigger thumb than those providers who completed additional training in congenital hand surgery. No statistically significant differences in practice patterns were appreciated for children aged 6 and 18 months.
Variability was appreciated in practice patterns for initial treatment recommendation for a patient presenting with PTT. Subspecialty training does appear to affect treatment recommendations for clinical scenarios involving a 3-year-old patient with PTT, although this trend is not observed when treating younger patients.
小儿扳机指（PTT）的恰当初始治疗仍存在争议。一些医疗服务提供者主张长期非手术治疗，而另一些人可能会提供手术松解以实现可靠且快速的解决办法。本研究的目的是阐明接受不同专科培训的外科医生治疗PTT患者的实践模式。我们假设外科医生的专科培训与治疗方案之间存在关联。
向3个专业组织的邮件列表发送了横断面调查问卷，其成员代表了大多数治疗小儿手部疾病的医疗服务提供者。受访者被问及他们的培训背景以及针对几种临床情况的治疗建议。对各亚专业的回答进行了比较。
在受访者中，444人完成了手外科专科培训，167人完成了小儿骨科专科培训，155人完成了额外的先天性手部专科培训。与完成小儿骨科专科培训的医生相比，接受手外科专科培训的医疗服务提供者更有可能将手术干预作为3岁灵活扳机指患者的一线治疗方法（P = .001），并且比完成先天性手部手术额外培训的医生更有可能对3岁间歇性（P = .007）、疼痛性（P = .015）或锁定性（P = .012）扳机指患者提供手术干预。对于6个月和18个月大的儿童，实践模式没有统计学上的显著差异。
对于PTT患者初始治疗建议的实践模式存在差异。专科培训似乎确实会影响涉及3岁PTT患者临床情况的治疗建议，尽管在治疗年龄较小的患者时未观察到这种趋势。
