Percutaneous release, open surgery, or corticosteroid injection, which is the best treatment method for trigger digits?

Abstract

Background: Percutaneous A1 pulley release surgery for trigger digit (finger or thumb) has gained popularity in recent decades. Although many studies have reported the failure rate and complications of percutaneous release for trigger digit, the best treatment for trigger digit remains unclear.

Questions/purposes: Our aim was to identify the relative risk of treatment failure, level of satisfaction, and frequency of complications, comparing percutaneous release with open surgery or corticosteroid injections for adult patients with trigger digits.

Methods: We searched PubMed, Embase, and the Cochrane Library for randomized controlled trials (RCTs), comparing percutaneous release with open surgery or corticosteroid injections. Seven RCTs involving 676 patients were identified. Methodologic quality was assessed by the Detsky quality scale. After data extraction, we compared results using a fixed meta-analysis model.

Results: There were no differences in the failure rate (risk ratio [RR] = 0.93; 95% CI, 0.14-6.25) and complication frequency (RR = 0.83; 95% CI, 0.15-4.72) between patients undergoing percutaneous release and open surgery. Patients treated with percutaneous release had fewer failures (RR = 0.07; 95% CI, 0.02-0.21) and a greater level of satisfaction (RR = 2.01; 95% CI, 1.62-2.48) compared with the patients treated with corticosteroid injections. We found no difference in complication frequency between percutaneous release and corticosteroid injection (RR = 3.19; 95% CI, 0.51-19.91).

Conclusions: The frequencies of treatment failure and complications were no different between percutaneous release surgery and open surgery for trigger digit in adults. Patients treated with percutaneous releases were less likely to have treatment failure than patients treated with corticosteroid injections.

Figures

Fig. 1

A flow diagram summarizes the selection of studies, including numbers and reasons for excluding certain studies. RCT = randomized controlled trial.

Fig. 2

The results show that there is no great difference in the failed procedure between percutaneous release and open surgery. PR = percutaneous release; OS = open surgery; Z = p value of weighted test for the overall effect; df = degrees of freedom; I2 = test statistic.

Fig. 3

The results show that there is no great difference in complications between percutaneous release and open surgery. PR = percutaneous release; OS = open surgery; Z = p value of weighted test for the overall effect; df = degrees of freedom; I2 = test statistic.

Fig. 4

The results show that there is substantial difference in the failed procedure between percutaneous release and corticosteroid injection. PR = percutaneous release; Z = p value of weighted test for overall effect; RR = risk ratios; df = degrees of freedom; I2 = test statistic.

Fig. 5

The results show that there is substantial difference in patient satisfaction between percutaneous release and corticosteroid injection. PR = percutaneous release; Z = p value of weighted test for overall effect; RR = risk ratios; df = degrees of freedom; I2 = test statistic.

Fig. 6

The results show that the difference of complication rate is trivial between percutaneous release and corticosteroid injection. PR = percutaneous release; Z = p value of weighted test for overall effect; RR = risk ratios; df = degrees of freedom; I2 = test statistic.