[Kapandji enlargement plasty of A1 pulley. Results in 15 primary trigger fingers with a 5 year (2-8 years) follow-up].
We retrospectively studied 15 enlargement plasties of the A1 pulley performed in a university orthopaedic department for trigger finger. The study objectives where: 1)to evaluate whether closure of the enlarged A1 pulley led to recurrent trigger finger; 2) to determine whether the complexity of the procedure was responsible for complications. Fifteen trigger fingers operated by enlargement of the A1 pulley according to Kapandji, instead of opening of the A1 pulley, were reviewed after 5 years of follow-up (2-8 years) by an observer who did not participate in surgery. These 15 fingers (6 thumbs, 7 ringer finger, 1 long finger and 1 index finger) were operated in 14 patients (11 females, 3 males) with a mean age of 55 years at surgery. All trigger fingers were primary (no patients had pathological conditions predisposing to trigger finger). After surgery, all symptoms resolved. No recurrence was observed during the follow-up period. No loss of range of motion or loss of sensation were observed. Reflex sympathetic dystrophy was observed in one case after surgery and resolved before the sixth postoperative month. The authors recommend this procedure, which doesn not lead to recurrence despite closure of the enlarged A1 pulley. Technically more demanding than simple A1 pulley opening, this procedure was safely performed in our department despite participation of junior surgeons.
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