Paper of the Week: Risk of Infection in Trigger Finger Release Surgery Following Corticosteroid Injection

Jonas L. Matzon, MD, Cory Lebowitz, DO, Jack G. Graham, BS, Ludovico Lucenti, MD, Kevin F. Lutsky, MD, Pedro K. Beredjiklian, MD

The Journal of Hand Surgery vol. 45,4 (2020): 310-316.
doi:10.1016/j.jhsa.2020.01.007

Summary by Clay Townsend, BS

Trigger finger (stenosing tenosynovitis) is a common condition that affects about 2% of the adult population, and can involve multiple fingers in some patients.¹ Conservative treatments, including corticosteroid injections, are typically exhausted before surgical release is pursued.  Due to a reported recurrence rate of 30-60% following corticosteroid injection for trigger finger, surgical release becomes indicated in many patients.^2,3,4 Many studies in adult reconstruction literature have reported an association between preoperative corticosteroid injection and an increased risk of infection following hip and knee arthroplasty.^5,6 This study aimed to determine if there is an increased infection risk following surgical release of trigger finger for patients who have received preoperative corticosteroid injections, and whether this risk is associated with the length of time between the injection and surgery.

Matzon et al. retrospectively reviewed 2,480 trigger fingers in 1,857 patients who underwent trigger finger release surgery by 16 Orthopaedic surgeons. Of those, 1,343 trigger fingers received a corticosteroid injection previously, and 1,137 trigger fingers did not receive a corticosteroid injection previously. Electronic medical records for each patient were reviewed to evaluate for postoperative superficial infection as defined by CDC criteria, and postoperative deep infection defined as the patient requiring an irrigation and debridement with intraoperative confirmation of a deep infection. The injection group was found to have a statistically significant increased risk for developing a deep infection postoperatively compared to the non-injection group (0.8% versus 0.1%; odds ratio, OR=9.38; 95% CI, 1.21-72.78; P < .05). There was no statistically significant difference found between the injection and non-injection group for superficial infections.

Patients who received an injection within 90 days before surgery had a statistically significant increased risk of developing a deep infection compared to patients who received an injection greater than 90 days before surgery (OR=6.51; 95% CI, 1.71-24.67; P < .05). Interestingly, there were no infections reported in patients who received an injection within 30 days before surgery. The results of this study suggest that patients undergoing trigger finger release surgery should wait at least 90 days from their most recent corticosteroid injection to mitigate the risk of developing a deep infection. Limitations of this study include it being retrospective and, therefore, nonrandomized. Treatment protocols of the 16 treating surgeons were not standardized, including perioperative antibiotic use. Some patients had trigger finger release performed in combination with another hand surgical procedure, which could potentially affect infection risk.

References:

1. Moore, J S. “Flexor tendon entrapment of the digits (trigger finger and trigger thumb).” Journal of occupational and environmental medicine vol. 42,5 (2000): 526-45. doi:10.1097/00043764-200005000-00012
2. Fleisch, Sheryl B et al. “Corticosteroid injections in the treatment of trigger finger: a level I and II systematic review.” The Journal of the American Academy of Orthopaedic Surgeons vol. 15,3 (2007): 166-71. doi:10.5435/00124635-200703000-00006
3. Rozental, Tamara D et al. “Trigger finger: prognostic indicators of recurrence following corticosteroid injection.” The Journal of bone and joint surgery. American volume vol. 90,8 (2008): 1665-72. doi:10.2106/JBJS.G.00693
4. Dala-Ali, Benan M et al. “The efficacy of steroid injection in the treatment of trigger finger.” Clinics in orthopedic surgery vol. 4,4 (2012): 263-8. doi:10.4055/cios.2012.4.4.263
5. Werner, Brian C et al. “The Timing of Total Hip Arthroplasty After Intraarticular Hip Injection Affects Postoperative Infection Risk.” The Journal of arthroplasty vol. 31,4 (2016): 820-3. doi:10.1016/j.arth.2015.08.032
6. Bedard, Nicholas A et al. “The John N. Insall Award: Do Intraarticular Injections Increase the Risk of Infection After TKA?.” Clinical orthopaedics and related research vol. 475,1 (2017): 45-52. doi:10.1007/s11999-016-4757-8