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Primary Surgical Release of Trigger Digits in Diabetics versus Nondiabetics: A Prospective Comparative Study
Claudius D. Jarrett, MD; Gary Mcgillivary, MD; Jonathan Gillig, MD; Michael Devon Smith, MD; Laura Tabilo, ATC; Vinura Withanawasam, MD
Emory University, Atlanta, GA

Hypothesis: Stenosis tenosynovitis (i.e. the trigger finger) remains one of the most common problems treated by hand surgeons. Numerous studies have documented a lower success rate of corticosteroid injections in diabetics versus non-diabetics for the treatment of trigger fingers. Surprisingly, few studies have posed to investigate the comparative outcome, speed of improvement, and complication rate following surgical intervention between these two patient populations. We hypothesize that diabetic patients will report a lower success rate and higher complication rate for trigger finger release in comparison to nondiabetics.

Methods: A prospective comparative study of 42 patients undergoing surgical intervention for recalcitrant trigger fingers was performed. Preoperative evaluation as well as outcomes at 2, 6, and 12 weeks postoperatively were conducted. Success rate of surgery, speed of improvement, and complication rates were compared between diabetic to nondiabetic patients. Subgroup analysis of the impact of type I versus type II diabetes, preoperative Hemaglobin A1C, as well as insulin versus noninsulin dependent control were performed.

Results: Both diabetic and non-diabetic cohorts exhibited a similar pre-operative DASH score of 31.62 and 31.85, respectively. (p > 0.05) Both groups appreciated equally successful improvement from surgical intervention with final DASH scores of 0.53 in diabetic patients and 3.05 in non-diabetic patients at final assessment. (p > 0.05) The speed of improvement was similar for both diabetics and nondiabetics at all time points. There was a trend for diabetic patients with a HgA1C < 8 to express quicker improvement than those with a HgA1C > 8. This trend approached but did not reach statistical significant. Approximately 35% of diabetics experience a post-operative complication compared to 10% of nondiabetics (p<0.05). The risk for having a post operative complication was significantly higher in insulin dependent versus non-insulin dependent diabetics (approximately 50% versus 0%, respectively) (p<0.05).

Summary: Diabetic and non-diabetic patients suffering from trigger fingers experience symptoms of similar severity.

  • Surgical intervention can reliably provide equal success rate for both diabetics and non-diabetics.
  • Diabetic patients experience a similar speed of improvement but a higher complication rate in comparison to non-diabetic patients.
  • Insulin-dependency appears to be a significant risk factor for post operative complications.
  • Diabetic patients should be appropriately counseled prior to undergoing surgical intervention for a recalcitrant trigger finger.

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