Operative versus conservative treatment of trigger thumb in children.

Trigger thumb is an uncommon anomaly in children with controversial management ranging from simple observation to surgical release. This study aimed to determine the clinical outcomes of surgical release versus conservative treatment. Data from 407 children with 511 trigger thumbs were collected from their medical records. To compare the final outcomes of conservative and operative treatments, age at onset, sex, affected side, familial history, treatment modality, time to conversion from conservative to surgical treatment, recurrence, and complications were analyzed. Forty-one children were excluded owing to loss during follow-up; thus, 366 children were finally included. Conservative treatment was administered to 96 children, of whom 25 experienced successful result and 68 experienced treatment failure and were subsequently treated surgically. There were no cases of post-operative recurrence. After 24 months of age, operative treatment had better outcomes than conservative treatment, which showed a higher failure rate.

Assessment of Clinical Outcome of Lumbar Transforaminal Foraminoplasty in Patients with Lumbar Spinal Stenosis.

BACKGROUND: Lumbar spinal stenosis (LSS), a common spinal disorder that negatively affects quality of life, is a disabling condition accompanied by back pain, leg pain, and claudication. Lumbar foraminal stenosis (LFS) is often accompanied by lumbar central stenosis (LCS) and conservative treatment is often ineffective. A surgical approach, including a minimally invasive technique, is usually recommended for the conservative treatment of refractory conditions. To achieve effective decompression of LSS, a specially designed new instrument for lumbar transforaminal foraminoplasty (TFFP) can be considered before opting for surgical treatment. OBJECTIVE: To evaluate the clinical outcomes and safety of TFFP with a specially designed instrument. STUDY DESIGN: Retrospective design. SETTING: This research was conducted in a hospital outpatient surgical center. METHODS: The medical records of 112 patients who underwent TFFP from December 1, 2018 to January 1, 2020, were reviewed. Outcome measures were obtained using the numeric rating scale for pain (NRS pain), Oswestry Disability Index (ODI), and walking distance without pain for functional ability at preprocedure and 1, 3, and 6 months postprocedure. The clinical data and radiologic findings were analyzed to evaluate correlations between predictive factors and efficacy of TFFP. RESULTS: Among 112 patients who underwent TFFP, 110 were accessed and analyzed. The percentage of successful responders was 59.1%, 73.6%, and 74.5 % of 110 patients at one, 3, and 6 months, respectively. The NRS pain score, ODI, and duration of walking without radicular pain were improved significantly at the one-, 3-, and 6-month follow-up periods (all P < 0.001). No serious adverse events occurred during this study. LIMITATIONS: The limitations of this study include the possibility of bias due to nonrandomized patient selection. CONCLUSION: TFFP using the Foramoon® device (Mcarekorea, Seongnam-si, Gyeonggi-do, Republic of Korea) appeared to be effective for managing patients with LFS and LCS, who were refractory to conservative care.