Arch Hand Microsurg.  2023 Mar;28(1):47-51. 10.12790/ahm.22.0058.

Resection of one slip of the flexor digitorum superficialis resulting finger deformity in pediatric trigger finger: a case report

• Kim D
• Yoon J
• Lim S
• Han Y
• Eo S

• KMID: 2540031
• DOI: http://doi.org/10.12790/ahm.22.0058

Abstract

Pediatric trigger finger (PTF) is a rare hand disorder caused by various anatomic abnormalities and systemic illnesses. We report a case of PTF in a 16-month-old boy, revealing a flexion deformity of his right middle finger. We noted an abnormally proximal location of Camper’s chiasm and bulging of the flexor digitorum profundus intraoperatively. We released the A1 pulley completely and resected an ulnar slip of the flexor digitorum superficialis (FDS). The short-term outcome was satisfactory; however, the patient experienced a mild flexion deformity and ulnar deviation of the right middle finger at a 4-year follow-up visit. During reexploration, we noted severe scar adhesion along the previously cut end of the ulnar slip of the FDS. Therefore, we performed en-bloc scar tissue release with additional resection of the remaining radial slip of the FDS. To prevent recurrence after PTF release, close monitoring with short-term follow-up and early physiotherapy should be emphasized.

Keyword

Hand; Trigger finger disorder; Pediatrics

Figure

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  Fig. 1. (A) A 16-month-old boy showed flexion deformity of his right middle finger. Active and passive extension was limited. (B) No bony abnormality was found on the trigger digit.

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  Fig. 2. Primary operation. (A) An abnormal location of Camper’s chiasm was noted, proximal to the A1 pulley (asterisk). Intact flexor digitorum profundus (arrow) and flexor digitorum superficialis (dotted arrow) were noted. (B) Resection of the ulnar slip of the flexor digitorum superficialis (FDS) with a length of 24 mm from Camper’s chiasm to the FDS insertion site was performed. (C) The remaining radial-side slip of the FDS was retracted using a Ragnell retractor (arrow, flexor digitorum profundus; dotted arrow, remaining FDS; arrowhead, A2 pulley).

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  Fig. 3. Ulnar deviation and mild flexion deformity of the right middle finger were noted at a 4-year follow-up.

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  Fig. 4. Second reoperation. (A) The remaining radial slip of the flexor digitorum superficialis (FDS) was retracted using a Ragnell retractor (arrow, flexor digitorum profundus [FDP]; arrowhead, A2 pulley; dotted arrow, FDS). (B) After resection of the remaining radial slip of the FDS from Camper’s chiasm to the FDS insertion site, the residual FDS slip was sutured to the FDP.

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  Fig. 5. No sign of flexion deformity was present on the right middle finger at a 1-year follow-up after the second operation.

Reference

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