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Direct repair of the sagittal band for extensor tendon subluxation caused by finger flicking

Direkte Wiederherstellung des sagittalen Bands bei Strecksehnensubluxation verursacht durch Fingerschnippen

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Abstract

Purpose

For patients with metacarpophalangeal (MCP) extensor tendon subluxation caused by finger flicking injury, we performed an extensor tendon realignment and direct repair technique. The purpose of this study was to evaluate the clinical outcome after direct repair of the sagittal band in patients with MCP extensor tendon subluxation caused by finger flicking injury and to introduce the repair technique.

Methods

A total of 26 patients with a mean age of 39.9 years were included in the study. The mean time from injury to surgery was 51.3 days. The ruptured sagittal band was reattached to the lateral side of the extensor tendon using a continuous interlocking suture. Patients were evaluated for pain using a visual analog scale (VAS), range of motion, long fingertip pinch strength, disabilities of the arm, shoulder, and hand (DASH) score, and the recurrence of extensor tendon subluxation or dislocation.

Results

All patients had full range of motion compared to the uninjured contralateral digit. Long fingertip pinch strength was also comparable to that of the contralateral digit in all patients. The DASH score was also improved from a preoperative average of 28.8 to a postoperative average of 1.0.

Conclusions

Realignment of the extensor tendon and direct repair of the superficial layer of the sagittal band to the extensor digitorum communis (EDC) tendon is recommended as a treatment option in patients with chronic MCP extensor tendon subluxation, as well as for acute MCP extensor tendon subluxation in patients that have failed or could not maintain conservative treatment approaches.

Zusammenfassung

Zielsetzung

Bei Patienten mit Subluxation der Strecksehne am Fingergrundgelenk (metakarpophalangeal [MCP]) durch eine Fingerschnippverletzung erfolgten eine Stellungskorrektur der Strecksehne und eine direkte Wiederherstellung. Ziel der Studie war es, das klinische Ergebnis nach direkter Wiederherstellung des sagittalen Bands bei Patienten mit MCP-Strecksehnensubluxation, verursacht durch eine Fingerschnippverletzung, zu beurteilen und das Wiederherstellungsverfahren zu etablieren.

Methoden

Insgesamt 26 Patienten in einem Durchschnittsalter von 39,9 Jahren wurden in die Studie eingeschlossen. Die durchschnittliche Zeitspanne von der Verletzung bis zum operativen Eingriff betrug 51,3 Tage. Das rupturierte sagittale Band wurde mit einer fortlaufenden Interlocking-Naht im lateralen Bereich der Strecksehne angebracht. Der Schmerz der Patienten wurde mithilfe einer visuellen Analogskala (VAS) bestimmt. Des Weiteren wurden der Bewegungsumfang, die Kraft des Mittelfingerspitzgriffs, die körperliche Einschränkung von Arm, Schulter und Hand (Disabilities of the Arm, Shoulder, and Hand [DASH] Score) sowie Rezidive der Strecksehnensubluxation oder Strecksehnenluxation erfasst.

Ergebnisse

Alle Patienten wiesen einen vollen Bewegungsumfang im Vergleich zum unverletzten kontralateralen Finger auf. Auch die Kraft des Mittelfingerspitzgriffs war bei allen Patienten mit der des kontralateralen Fingers vergleichbar. Verbessert war zudem der DASH-Score: von durchschnittlich 28,8 präoperativ auf 1,0 postoperativ.

Schlussfolgerungen

Die Stellungskorrektur der Strecksehne und direkte Befestigung der oberflächlichen Schicht des sagittalen Bands an der Sehne des Extensor digitorum communis wird als Behandlungsoption für Patienten mit chronischer MCP-Strecksehnensubluxation empfohlen. Empfohlen wird das Verfahren auch für Patienten mit akuter MCP-Strecksehnensubluxation, wenn konservative Behandlungsansätze gescheitert sind oder die Patienten die Behandlung nicht aufrechterhalten können.

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Abbreviations

EDC:

Extensor digitorum communis

MCP:

Metacarpophalangeal (joint)

IRB:

Institutional review board

IP:

Interphalangeal (joints)

TAM:

Total active motion

DASH:

Disabilities of the arm, shoulder, and hand

VAS:

Visual analog scale

References

  1. Andruss RJ, Herndon JH (1993) Ulnar subluxation of the extensor digitorum communis tendon: a case report and review of the literature. Iowa Orthop J 13:208–213

    CAS  PubMed  PubMed Central  Google Scholar 

  2. Beck JD, Riehl JT, Klena JC (2012) Anomalous tendon to the middle finger for sagittal band reconstruction: report of 2 cases. J Hand Surg Am 37:1646–1649

    Article  PubMed  Google Scholar 

  3. Carroll CT, Moore JR, Weiland AJ (1987) Posttraumatic ulnar subluxation of the extensor tendons: a reconstructive technique. J Hand Surg Am 12:227–231

    Article  PubMed  Google Scholar 

  4. Elmaraghy AW, Pennings A (2013) Metacarpophalangeal joint extensor tendon subluxation: a reconstructive stabilization technique. J Hand Surg Am 38:578–582. doi:10.1016/j.jhsa.2012.12.021

    Article  PubMed  Google Scholar 

  5. Inoue G, Tamura Y (1996) Dislocation of the extensor tendons over the metacarpophalangeal joints. J Hand Surg Am 21:464–469. doi:10.1016/S0363-5023(96)80364-9

    Article  CAS  PubMed  Google Scholar 

  6. Ishizuki M (1990) Traumatic and spontaneous dislocation of extensor tendon of the long finger. J Hand Surg Am 15:967–972

    Article  CAS  PubMed  Google Scholar 

  7. Kang L, Carlson MG (2010) Extensor tendon centralization at the metacarpophalangeal joint: surgical technique. J Hand Surg Am 35:1194–1197. doi:10.1016/j.jhsa.2010.04.029

    Article  PubMed  Google Scholar 

  8. Kettelkamp DB, Flatt AE, Moulds R (1971) Traumatic dislocation of the long-finger extensor tendon: a clinical, anatomical, and biomechanical study. J Bone Joint Surg Am 53:229–240

    Article  CAS  PubMed  Google Scholar 

  9. Langer MF, Wieskötter B, Hartensuer R, Kösters C, Oeckenpöhler S (2015) Bandplastik bei Strecksehnenluxation über dem Fingergrundgelenk. Oper Orthop Traumatol 27(5):394–403. doi:10.1007/s00064-015-0419-3

    Article  CAS  PubMed  Google Scholar 

  10. Lin JD, Strauch RJ (2014) Closed soft tissue extensor mechanism injuries (mallet, boutonniere, and sagittal band). J Hand Surg Am 39:1005–1011. doi:10.1016/j.jhsa.2013.11.018

    Article  PubMed  Google Scholar 

  11. McCoy FJ, Winsky AJ (1969) Lumbrical loop operation for luxation of the extensor tendons of the hand. Plast Reconstr Surg 44:142–146

    Article  CAS  PubMed  Google Scholar 

  12. Proubasta I, Lamas C, Abat F, Sarasquete J, Itarte J (2011) Luxation of the hand extensor tendons around the metacarpophalangeal joint. Rev Eesp Cir Traumatol Ortop 55(2):105–109. doi:10.1016/S1988-8856(11)70290-5

    Google Scholar 

  13. Rayan GM, Murray D (1997) Classification and treatment of closed sagittal band injuries. J Hand Surg Am 19(4):590–594

    Article  Google Scholar 

  14. Rayan GM, Murray D, Chung KW et al (1997) The extensor retinacular system at the metacarpophalangeal joint. Anatomical and histological study. J Hand Surg Am 22B:585–590. doi:10.1016/S0266-7681(97)80351-8

    Article  Google Scholar 

  15. Shinohara T, Nakamura R, Suzuki M, Maeda N (2005) Extensor mechanism laxity at the metacarpophalangeal joint as identified by a new provocative test: Predisposition to dislocation. J Hand Surg Am 30(1):79–82. doi:10.1016/j.jhsb.2004.09.002

    Article  CAS  Google Scholar 

  16. Watson HK, Weinzweig J, Guidera PM (1997) Sagittal band reconstruction. J Hand Surg Am 22:452–456. doi:10.1016/S0363-5023(97)80012-3

    Article  CAS  PubMed  Google Scholar 

  17. Young CM, Rayan GM (2000) The sagittal band: anatomic and biomechanical study. J Hand Surg Am 25:1107–1113. doi:10.1053/jhsu.2000.18495

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam-si, Gyeonggi-do, Republic of Korea

    In Tae Hong MD MS, Chi Hoon Oh MD, Young Suk Sim MD & Soo Hong Han MD PhD

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  1. In Tae Hong MD MS
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  2. Chi Hoon Oh MD
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Correspondence to Soo Hong Han MD PhD.

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Conflict of interest

I.T. Hong, C.H. Oh, Y.S. Sim and S.H. Han declare that they have no competing interests.

.All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

Additional information

Level of Evidence: Therapeutic case-control study (Level III)

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Hong, I.T., Oh, C.H., Sim, Y.S. et al. Direct repair of the sagittal band for extensor tendon subluxation caused by finger flicking. Orthopäde 46, 755–760 (2017). https://doi.org/10.1007/s00132-017-3450-2

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