Percutaneous versus open release for trigger finger: a retrospective comparison of outcomes, complications, and costs in 110 patients from a Swedish cohort

BACKGROUND: Trigger finger (TF) is a common hand condition often requiring surgery. Open surgery (OS) is the standard treatment, with high success rates. Percutaneous release (PR) offers potential advantages regarding cost, procedure time, and recovery, although its effectiveness remains debated in different clinical settings. This study compares outcomes, complications, and resource use between PR and OS in a Swedish hospital setting where PR was newly introduced. METHODS: We conducted a retrospective observational study including 110 patients treated for TF between 2018 and 2020 at the Department of Orthopaedics, Falu Regional Hospital, Falun, Sweden. Fifty fingers underwent PR and 94 fingers were treated with OS. PR was performed by two surgeons with procedure-specific expertise corresponding to level 1 and 2, respectively. The primary outcome was elimination of triggering, evaluated through follow-up visits or phone interviews at a median of 39.5 months (interquartile range 13) post-treatment. Secondary outcomes included complications, additional treatments, DASH scores, extension deficits, and estimated treatment costs. RESULTS: Triggering was resolved in 26/50 (52%) fingers treated with PR and 87/94 (93%) treated with OS (p < 0.001). Secondary interventions were required in 19 (38%) PR cases versus 2 (2%) in the OS group. No major complications (e.g. neurovascular or tendon injury) were reported. Minor transient symptoms (e.g. tenderness, scar pain) were reported by 8% of PR patients and 6% of OS patients. Estimated treatment cost per patient was 53 USD for PR and 138 USD for OS. Despite lower effectiveness, 69% of PR patients indicated willingness to undergo the same procedure again, compared to 97% in the OS group. CONCLUSIONS: While percutaneous release of the A1 pulley is safe, it was significantly less effective in eliminating triggering compared to open surgery. The procedure might be more technically demanding than previously assumed. Further prospective studies are needed to clarify its cost-effectiveness in different clinical settings, e.g. when performed by less experienced surgeons. LEVEL OF EVIDENCE: Level III. CLINICAL TRIAL REGISTRATION: Ethical Review Board of Region Dalarna, Dnr 2020-07205, dated February 17, 2021.