When Full Extension Falls Short: Age and Preoperative Deformity After Persistent Pediatric Trigger Thumb Surgery
4 affiliations
- 1Division of Hand Surgery, Department of Orthopaedics and Traumatology, Etlik City Hospital, University of Health Sciences, 06170 Ankara, Türkiye
- 2Department of Orthopaedics and Traumatology, Denizli State Hospital, 20150 Denizli, Türkiye
- 3Department of Orthopaedics and Traumatology, Ataturk Sanatoryum Training and Research Hospital, University of Health Sciences, 06290 Ankara, Türkiye
- 4Department of Orthopaedics and Traumatology, Liv Hospital Vadistanbul, 34396 Istanbul, Türkiye
Abstract
Background: The optimal timing of surgery for persistent pediatric trigger thumb remains controversial, and evidence regarding clinical factors associated with residual extension deficit after surgery is limited. This study evaluated postoperative improvement in active interphalangeal (IP) joint extension and explored preoperative factors associated with residual active extension deficit. Methods: We retrospectively reviewed 26 consecutive patients aged 3–12 years at diagnosis who underwent open A1 pulley release for persistent pediatric trigger thumb between 2012 and 2021. Preoperative and final active IP extension values were extracted from routine clinical notes. Complete correction was defined as active extension to neutral (0°) or beyond, whereas an extension deficit >0° was classified as residual active extension deficit. The last pre-revision assessment was used for the patient who underwent reoperation. Clinical and demographic factors were compared between outcome groups using exact tests on an exploratory basis. Results: At a median follow-up of 10 months, complete correction was achieved in 21 patients (80.8%), while five (19.2%) had residual active extension deficit. Four of these five patients had a residual deficit of 1–9°, and one had a deficit of 10–19°. Passive extension restriction accompanied the active deficit in two patients. Patients with residual active extension deficit were older at diagnosis (median, 10.6 vs. 3.8 years) and surgery (median, 10.7 vs. 4.0 years) and had greater preoperative active IP extension deficits (median, 45.0° vs. 20.0°; all p < 0.001). The distribution of primary presenting complaints also differed between groups (p = 0.009). Four patients with residual deficits reported no ongoing complaints; one underwent revision release at nine months for residual limitation accompanied by functional difficulty. No wound, infectious, or neurovascular complications were recorded. Conclusions: Open A1 pulley release resulted in active IP extension to neutral or beyond in most patients with persistent pediatric trigger thumb. Older age and greater preoperative active extension deficit were associated with residual postoperative active extension deficit, although most residual deficits were mild. These associations remain exploratory; their independent prognostic value and clinical significance require confirmation in larger studies with longer follow-up and standardized functional assessment.
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BibTeX
@article{karaduman2026when,
title = {{When Full Extension Falls Short: Age and Preoperative Deformity After Persistent Pediatric Trigger Thumb Surgery}},
author = {Mert Karaduman and Caner Öğük and Hakan Şeşen and İsmail Demirkale and Murat Altay},
journal = {Journal of Clinical Medicine},
year = {2026},
month = nov,
doi = {10.3390/jcm15218686},
url = {https://www.mdpi.com/2077-0383/15/21/8686},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - When Full Extension Falls Short: Age and Preoperative Deformity After Persistent Pediatric Trigger Thumb Surgery
AU - Mert Karaduman
AU - Caner Öğük
AU - Hakan Şeşen
AU - İsmail Demirkale
AU - Murat Altay
PY - 2026
DA - 2026/11/07
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15218686
UR - https://www.mdpi.com/2077-0383/15/21/8686
AB - Background: The optimal timing of surgery for persistent pediatric trigger thumb remains controversial, and evidence regarding clinical factors associated with residual extension deficit after surgery is limited. This study evaluated postoperative improvement in active interphalangeal (IP) joint extension and explored preoperative factors associated with residual active extension deficit. Methods: We retrospectively reviewed 26 consecutive patients aged 3–12 years at diagnosis who underwent open A1 pulley release for persistent pediatric trigger thumb between 2012 and 2021. Preoperative and final active IP extension values were extracted from routine clinical notes. Complete correction was defined as active extension to neutral (0°) or beyond, whereas an extension deficit >0° was classified as residual active extension deficit. The last pre-revision assessment was used for the patient who underwent reoperation. Clinical and demographic factors were compared between outcome groups using exact tests on an exploratory basis. Results: At a median follow-up of 10 months, complete correction was achieved in 21 patients (80.8%), while five (19.2%) had residual active extension deficit. Four of these five patients had a residual deficit of 1–9°, and one had a deficit of 10–19°. Passive extension restriction accompanied the active deficit in two patients. Patients with residual active extension deficit were older at diagnosis (median, 10.6 vs. 3.8 years) and surgery (median, 10.7 vs. 4.0 years) and had greater preoperative active IP extension deficits (median, 45.0° vs. 20.0°; all p < 0.001). The distribution of primary presenting complaints also differed between groups (p = 0.009). Four patients with residual deficits reported no ongoing complaints; one underwent revision release at nine months for residual limitation accompanied by functional difficulty. No wound, infectious, or neurovascular complications were recorded. Conclusions: Open A1 pulley release resulted in active IP extension to neutral or beyond in most patients with persistent pediatric trigger thumb. Older age and greater preoperative active extension deficit were associated with residual postoperative active extension deficit, although most residual deficits were mild. These associations remain exploratory; their independent prognostic value and clinical significance require confirmation in larger studies with longer follow-up and standardized functional assessment.
SN - 2077-0383
ER -