gms | German Medical Science

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

Reconstruction of Extensor Tendons in Multiple Subcutaneous Rupture of Rheumatoid Fingers

Meeting Abstract

  • presenting/speaker Masayuki Sekiguchi - Department of Orthopaedic Surgery, School of Medicine, Toho University, Tokyo, Japan
  • Ayako Kubota - Department of Orthopaedic Surgery, School of Medicine, Toho University, Tokyo, Japan
  • Tatsurou Sakurai - Department of Orthopaedic Surgery, School of Medicine, Toho University, Tokyo, Japan
  • Kentaro Tsuji - Department of Orthopaedic Surgery, School of Medicine, Toho University, Tokyo, Japan
  • Takashi Arai - Department of Orthopaedic Surgery, School of Medicine, Toho University, Tokyo, Japan
  • Shinji Taniguchi - Department of Orthopaedic Surgery, Toho University, Sakura Medical Center, Chiba, Japan
  • Shigeta Takeuchi - Department of Orthopaedic Surgery, School of Medicine, Toho University, Tokyo, Japan
  • Taisei Sako - Department of Orthopaedic Surgery, School of Medicine, Toho University, Tokyo, Japan
  • Hiroshi Takahashi - Department of Orthopaedic Surgery, School of Medicine, Toho University, Tokyo, 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. DocIFSSH19-848

doi: 10.3205/19ifssh0228, urn:nbn:de:0183-19ifssh02289

Veröffentlicht: 6. Februar 2020

© 2020 Sekiguchi et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Purpose: Although various methods have been reported for reconstructing multiple subcutaneous tendon rupture in patients with rheumatoid arthritis, satisfactory results have not necessarily been obtained. We attempted a new reconstruction method in which the tendon of the proximal side was reversed and sutured to the distal side. Postoperative results and usefulness of this method were examined.

Subjects: The subject of this study were cases of subcutaneous rupture of multiple tendons. Twenty-seven patients with RA were able to follow up for more than one year after surgery. Two cases were men and 25 cases were women, and the age at the time of surgery was 29 to 82 years old.

Reconstruction method: For the two fingers on the ulna side, the proximal side tendon of either EDC 4 or EDC 5 was reversed and sutured to the ruptured tendons on the distal side. In addition, for the three tendon ruptured cases, the proximal side tendon of either EDC 3 or EDC 4 was reversed. EDC 5 tendon on the distal side was sutured to EDC 4 tendon, but in cases with short tendon on the distal side, EIP tendon was transferred to distal tendon of EDC 5 / EDM. After the surgery, the affected fingers were buddy taped with undamaged fingers, and active motion exercise was permitted from the early postoperative day. It was fixed with splint at the extension position of fingers and wrist during night.

Result: At the time of investigation, the average angle of ROM (extension / flexion) of MCP joints was as follows. Cases with three tendons ruptured: long finger 0.71±9.32/73.6±9.88, ring finger 0.71±12.39/76.4±16.33, little finger 0±9.57/71.4±19.30. Two tendon rupture cases: ring finger -3.0±5.70/72.0±18.91, little finger 3.0±9.08 /70.0±23.18.

Discussion: Since myostatic contracture is the source of contraction force in ruptured muscle, it takes a long time to improve muscle contraction. However, excellent extension range is obtained as the muscle contraction of the ruptured muscle is recovered. In addition, it is considered that excellent range of motion is obtained because the reconstructed tendon runs similar to the normal tendon.

Summary: Our new reconstruction method of reversing the proximal side of torn tendon is a useful method for reconstructing multiple subcutaneous extensor tendon ruptures.