Timing of Carpal Tunnel or Trigger Finger Release After a Steroid Injection In The Operative Hand
Riikka E Koso, MD1, Asher B. Mirvish, BA2, Confidence Njoku-Austin, B.A.3, Hannah Piston, B.S.3, Runjia Li, M.S.4 and John R. Fowler, MD5, (1)UPMC, Pittsburgh, PA, (2)University of Pittsburgh School of Medicine, Pittsburgh, PA, (3)University of Pittsburgh Medical Center, Pittsburgh, PA, (4)University of Pittsburgh, Pittsburgh, PA, (5)Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
Introduction: Post-operative infection after carpal tunnel release (CTR) and trigger finger release (TFR) ranges from 0.2% to 1.0%, but is increased in patients who receive an corticosteroid injection at the surgical site within 90 days of surgery. It is not known if an injection elsewhere in the palm within 90 days of TFR or CTR alters the risk of post-operative infection.
A retrospective chart review was performed on all TFR and CTR surgeries performed at an academic institution by 8 hand sub-specialty trained surgeons between 2010-2022. Patients were included if they had a trigger finger injection (TFI) or carpal tunnel injection (CTI) within 90 days of TFR or CTR. Outcome measures included uncomplicated healing, superficial infection (SI) requiring antibiotics, and deep infection (DI) requiring surgical debridement. Multivariate analyses were performed assessing infection after â€˜adjacent-siteâ€™ injections (TFI then TFR of a different finger, TFI then CTR, or CTI then TFR. Results were compared to the infection rates in patients who had â€˜same-siteâ€™ injections â€“ (CTI then CTR, TFI then TFR of the same finger) within 90 days surgery. The effect of an injection 0-30 days, 31-60 days, and 61-90 days prior to surgery on subsequent postoperative infection was also evaluated.
There were 570 instances out of 35,373 CTR and TFR surgeries in which a cortisone injection was performed within 90 days of surgery (Table 1). There were 12 superficial infections (SI; 2.1%) and 6 deep infections (DI; 1.1%; Table 2). No difference was found in post-operative infection rates after a â€˜same-siteâ€™ injection at the surgical site as compared to an â€˜adjacent siteâ€™ injection (e.g. TFI followed by CTR). There was a slight but significant increase in post-operative infections in â€˜adjacent-siteâ€™ injections performed 61-90 days preoperatively (p < 0.05). There was no relationship between postoperative infection and diabetes or smoking history.
Summary: Although infection after trigger finger release and carpal tunnel release is uncommon, there is an increased risk if a corticosteroid injection is performed at the surgical site within 90 days of surgery. Similarly, an â€˜adjacent siteâ€™ cortisone injection may confer increased, albeit low, risk of an infection.
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