Cortisone Shots Before Trigger Finger Releases Associated With Serious Infections Afterwards

What’s the Claim?

This large-database study found that patients who undergo open trigger finger release within one month of a corticosteroid injection were at about three times the risk of developing a postoperative infection requiring surgical debridement 60 or 90 days later.

How’s It Stack Up?

Prior studies on this topic have disagreed, with some finding corticosteroid injection to be associated with increased risk and others finding it was not. This study, which evaluated nearly 15,000 patients, was large enough to shed light on rare complications like infection. Corticosteroid shots in other anatomic locations prior to surgery have been associated with infections afterwards; for example, similarly designed large-database studies have found that hip or knee injections before arthroplasty are associated with prosthetic joint infections, lending some credence to the finding here.

What’s Our Take?

Based on these findings, it seems reasonable to delay surgery when possible since these weren’t minor infections treated with oral antibiotics, they were serious complications resulting in surgical debridement. While the odds ratios were high — in the neighborhood of 3 — the confidence intervals are wide, meaning the magnitude of risk increase associated with shots may be lower or higher than that. Male patients also were more likely to get an infection than were female patients, with an effect size in the same ballpark as a recent cortisone shot. Obviously, sex is not a modifiable risk factor in this context, but postponing surgery a few months usually is.

Source

Straszewski AJ, Lee CS, Dickherber JL, Wolf JM. Temporal Relationship of Corticosteroid Injection and Open Release for Trigger Finger and Correlation With Postoperative Deep Infection. J Hand Surg Vol. 2022;47;1116.e1-1116.e11.

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