Outcomes of Conservative and Surgical Management of Trigger Thumb in Children Up to Five Years at a Tertiary Care Center in Kolkata

INTRODUCTION: Pediatric trigger thumb is a developmental condition characterized by flexion deformity of the interphalangeal joint due to constriction at the A1 pulley. Although spontaneous resolution has been reported, optimal treatment timing remains controversial. This study aimed to compare outcomes between conservative and surgical management in children aged up to five years. METHODOLOGY: A prospective analytical cohort study was conducted at a tertiary care center in Kolkata over 18 months. Fifty-eight children with clinically diagnosed trigger thumb were enrolled. All participants initially underwent six months of conservative observation. Those who did not improve underwent open A1 pulley release. The primary outcome was complete resolution of deformity. Secondary outcomes included degree of improvement, recurrence, complications, and time to resolution. Statistical analyses included the chi-square test, the Mann-Whitney U test, the Cox proportional hazards model, and multivariable logistic regression. RESULTS: Nineteen children (32.8%) improved with conservative management, whereas 39 (67.2%) required surgery. Surgical intervention achieved 100% resolution with no recurrence or major complications. Mean improvement in deformity was significantly greater in the surgical group (50.8° ± 5.8°) compared with the conservative group (14.5° ± 3.7°; p < 0.001). The relative risk of complete resolution with surgery was 3.05 (95% confidence interval (CI): 2.05-4.55), with an absolute risk reduction of 67.2% and a number needed to treat of approximately two. Cox analysis demonstrated faster recovery with surgery (HR: 4.62; 95% CI: 2.71-7.88; p < 0.001). An initial deformity of >20° independently predicted conservative failure. CONCLUSION: Surgical release provides significantly superior and faster resolution compared to conservative management, particularly in children presenting with deformity greater than 20°.