A Comparative Review of Surgical and Conservative Outcomes in Pediatric Gamekeeper’s Thumb

Research Objectives: To characterize pediatric gamekeeper’s thumb injuries and to compare outcome data stratified by injury severity and treatment modality to identify possible recommendations for improved management of future pediatric gamekeeper’s thumb patients.

Design: Retrospective chart review of the Nemours Children’s Health database of pediatric gamekeeper's thumb patients receiving care at a Nemours location from 2005-2020. Injury, outcome, and demographic data was collected and analyzed stratified by grade of injury.

Setting: Nemours Children's Health System database, including inpatient and outpatient patient records.

Participants: Cases were identified using ICD-10 codes that may be used to indicate thumb UCL injuries. Codes yielded 179 cases, of which 34 were confirmed UCL injuries.

Interventions: Interventions compared in this study include conservative bracing vs surgical UCL repair.

Main Outcome Measures: Primary outcome measures included time until full recovery (defined as patient being cleared for full return to activity) and any treatment complications.

Results: 15 injuries were grade I and all treated conservatively with average recovery time of 33.47±7.38 days. 11 injuries were grade II and all treated conservatively, with average recovery time of 80.09±30.48 days. 8 injuries were grade III, 2 received surgical treatment and healed with an average time of 67.5±18.62 days. 6 were initially treated conservatively, of these 3 healed successfully with an average of 44.67±18.81 days, while 3 failed treatment and required surgery with an average recovery time of 723.0±64.68 days. Variation in recovery time between grades of injury and initial treatments of grade III subgroups was statistically significant. Demographic data for these 34 patients showed average age of 14.03 years. 82.4% of injuries were sports related, with football the most common mechanism of injury for males and volleyball for females.

Conclusions: In the pediatric population, gamekeeper’s thumb injuries are most common in teenage athletes. The data from this study suggests conservative treatment is sufficient for grade I and II injuries, but grade III injuries may be better suited with initial surgical treatment. Further study with larger sample size is warranted.

Author(s) Disclosures: No conflicts of interest to declare