Plastic Surgery Research Council
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COMPARISON OF PERCUTANEOUS RELEASE, OPEN RELEASE, ENDOSCOPIC AND CORTICOSTEROID INJECTION IN THE TREATMENT OF TRIGGER DIGITS; A SYSTEMATIC REVIEW AND META-ANALYSIS
Presenter: Arash Izadpanah, MD
Co-Authors: Zein M; Izadpanah A; Kanevsky J; Izadpanah A; Belzile E; Shafran V; Shararah A; Luc M; Zadeh T
McGill University

Background: Stenosing flexor tenosynovitis is a common condition that causes locking, dysfunction and pain of the affected digits. The current available treatments are splinting, corticosteroid injection, percutaneous, endoscopic, and open release. The purpose of this study is to evaluate and compare the efficacy and complications of these treatment modalities in surgical treatments of trigger fingers.

Method: A literature review of all published data of trigger finger treatments from 1965 to 2012 was performed. All articles were reviewed for study design, reports of clinical cases, complications, administered doses, previous therapies, operative time, follow-up, and recurrence rate. Comparison of success rates between groups was performed using contingency tables and chi-square tests. We then proceeded with performing meta-analysis based on treatment modality and study designs.

Results: Ultrasound-guided percutaneous release was associated with the highest success rate (98%) followed by open surgical release (94.2%,), percutaneous release (91.9%), and steroid injection (70.2%) (p<0.05). Meta-analysis with random effects model demonstrated percutaneous release to have 94% [95% CI: 90%-98%] chance of success, compared to 92% [95% CI: 81%-98%] in open release group and only 65% [95% CI: 53%-76%] in corticosteroid administration group. However, there was considerable heterogeneity between studies.

Conclusion: Current data suggests that percutaneous release as a treatment of trigger finger has similar efficacy to open surgical release and both are superior to corticosteroid injection. Furthermore, ultrasound-guided percutaneous release shows promise as a new alternative therapy. However, the heterogeneity of studies done to date limits general application of the data and must be considered when studying the current body of evidence.


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