Trigger finger is a widespread condition in the general population, affecting approximately 2.6% of persons [1]. The underlying causes are controversial, with several suggested etiologies: metacarpophalangeal joint abnormalities, pulley thickening, or origin in the carpal tunnel [2], [3], [4].

One of the challenges in managing trigger finger is its association with an extension deficit of the proximal interphalangeal joint (PIP) or fixed flexion deformity. This extension deficit can occur in chronic cases [5] or in the presence of comorbidities such as diabetes, amyloidosis or rheumatoid arthritis [6]. Managing trigger finger becomes more complex when dealing with these additional factors that contribute to PIP fixed flexion deformity.

Although opening the A1 pulley is currently the most widely performed surgical treatment, its impact on fixed flexion deformity correction is limited and inconsistent [1]. Moreover, it can lead to postoperative complications, as it is often challenging to differentiate and avoid damaging the A2 pulley during surgery [7]. In 2004, Le Viet et al. [8] described a surgical technique called ulnar superficialis slip resection (USSR), which effectively addresses the symptoms of trigger finger as well as the PIP extension deficit by resecting the ulnar band of the superficial flexor of the fingers.

The primary objective of the present study was to compare clinical outcomes between these two techniques for trigger finger surgery, with or without PIP fixed flexion deformity. The study hypothesis was the non-inferiority of USSR compared to pulley opening. The secondary objective was to assess the correction of fixed flexion deformity using the USSR technique.