Surgical Correction of Extensor Tendon Subluxation and Ulnar Drift in the Rheumatoid Hand: Long-Term Results

Abstract

Subluxation of the extensor digitorum communis tendons in the rheumatoid hand causes ulnar digital drift. If passively correctable, the digit may be realigned by soft tissue rebalancing and extensor centralization, which may preserve a more functional arc of motion than achieved with arthroplasty. A total of 71 centralization procedures were done in 15 rheumatoid patients with a mean age of 55 years and an average follow-up of 9 years. A distally based central-third strip of extensor tendon was used. Correction of ulnar drift deformity was from an average of 47 degrees preoperatively to 7.9 degrees postoperatively, and correction of active range of motion of the metacarpophalangeal joints was from an average of 38 degrees to 56.2 degrees. Reoperation and complication rates were low. This technique corrects and maintains ulnar drift in the rheumatoid hand. Range of motion at the metacarpophalangeal joint level is improved and converted to a more functional one by decreasing the extensor lag.

Radially subluxated extensor tendons after a karate demonstration

“…2 Subluxation also occurs after traumatic injury, with ulnar subluxation after radial sagittal band disruption being the normal finding. Two cadaveric studies have confirmed the biomechanical favourability of ulnar subluxation occurring.…”

Sagittal band reconstruction in the index finger using a modified Elson technique

“…Dislocation of the extensor digitorum communis (EDC) tendon over the metacarpophalangeal (MCP) joints is mostly caused by disruption of the sagittal band that acts as the main lateral stabilizer, 1 although the etiology of EDC tendon dislocation remains controversial. [2][3][4] Causes of EDC tendon dislocation are divided into the rheumatoid and nonrheumatoid groups, 2,[5][6][7][8] with the nonrheumatoid group further subdivided into the traumatic and nontraumatic groups with spontaneous or congenital tendon dislocations resulting from a hypoplastic or absent sagittal band. 2,8,9 The EDC tendon dislocation commonly occurs post-trauma or in the rheumatoid hand, with cases involving spontaneous or congenital conditions rare.…”

Die In-vitro-Stabilität des Langfingergrundgelenkes nach endoprothetischer Versorgung mit Silastik-Implantaten (Sutter) und Oberflächenersatz (Avanta)

“…Reoperations-und Komplikationsraten waren niedrig. Sie folgerten, dass diese Methode die Ulnardeviation der rheumatischen Hand korrigiert[9].Somit ist der Langzeiterfolg einer prothetischen MCP-Gelenkversorgung von sehr vielen Faktoren abhängig. Die Versorgung des MCP-Gelenkes mit einer Prothese führt bei intaktem oder gut rekonstruiertem Bandapparat mit hoher Wahrscheinlichkeit zu besseren langfristigen Erfolgen.…”