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14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Soft tissue reconstruction for preserving metacarpophalamgeal joints in the rheumatoid hand

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  • presenting/speaker Takaaki Shinohara - Hand and Microsurgery Center, Daido Hospital, Nagoya, Japan
  • Tatsuo Watanabe - Hand and Microsurgery Center, Daido Hospital, Nagoya, Japan
  • Kimitoshi Noto - Hand and Microsurgery Center, Daido Hospital, Nagoay, Japan
  • Takamasa Masuda - Hand and Microsurgery Center, Daido Hospital, Nagoya, Japan
  • Taiji Iwasawa - Hand and Microsurgery Center, Daido Hospital, Nagoya, Japan

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-507

doi: 10.3205/19ifssh0226, urn:nbn:de:0183-19ifssh02262

Published: February 6, 2020

© 2020 Shinohara et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objectives/Interrogation: Implant arthroplasty is popular surgical procedure for correcting metacarpophalangeal (MP) joint deformity in rheumatoid arthritis (RA) patients. However, there are several problems such as infection, implant breakage, limitation of MP joint flexion. This study reports the surgical results of soft tissue reconstruction for preserving MP joints in rheumatoid hand with ulnar drift and extension loss of the fingers.

Methods: We retrospectively reviewed 21 fingers in 6 RA patients with ulnar drift and extension loss of the fingers who had undergone soft tissue MP reconstruction. Our indication for this procedure are: (1) RA well controlled by medication; (2) MP joint not severely destructed; (3) MP joint is passively correctable. The mean age at the time of surgery was 60 years (range, 55-71). The mean follow-up was 36 months (range, 13-72). Soft tissue MP reconstruction was basically performed in accordance with the method previously described by Wood et al. Crossed intrinsic transfer was done only in 2 fingers that showed severe ulnar drift (more than 65 degrees). The dislocated extensor tendon was sutured on the dorsal base of the proximal phalanx in all fingers. All patients were evaluated for active range of motion of the MP joints and the degree of ulnar drift in maximum active extension preoperatively and at final follow-up. Comparisons between preoperative and final follow-up active range of motion and the degree of ulnar drift were performed. Postoperative complications were also assessed.

Results and Conclusions: The active finger extension of the MP joint was significantly improved from a preoperative average of -42° (range, -80°-0°) to -9° (range, -35°-0°). The active finger flexion of the MP joint did not change from a preoperative average of 93° (range, 73°-110°) to 93° (range, 50°-110°). The degree of ulnar drift was significantly improved from a preoperative average of 35° (range, 10°-80°) to 9° (range, 0°-35°). There were no serious surgical complications.

There are several limitations, including small number of patients and short-term results. However, our procedures provides good results without serious complications if the MP joint not severely destructed and is passively correctable.