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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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Half Extensor Digiti Minimi Transfer for Thumb Extension Reconstruction

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  • presenting/speaker Jung-Hsien Hsieh - National Taiwan University Hospital, Taipei, Taiwan
  • Hao-Chih Tai - National Taiwan University Hospital, Taipei, Taiwan

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. DocIFSSH19-198

doi: 10.3205/19ifssh0285, urn:nbn:de:0183-19ifssh02856

Published: February 6, 2020

© 2020 Hsieh 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: Tendon transfer is the favored surgical procedure when extensor pollicis longus (EPL) rupture is chronic or poor quality of ruptured tendon ends. The extensor indicis proprius (EIP) is the most common used donor tendon for EPL reconstruction. Several other tendon transfer donors have been reported; including extensor pollicis brevis (EPB), extensor carpi radialis longus (ECRL), and palmaris longus. We reported a successful reconstruction of thumb extension by half extensor digiti minim (EDM) transfer in a patient with traumatic loss of EPL and EIP. A literature review failed to identify any English reports regarding thumb extension reconstruction using half EDM transfer. Only two total EDM transfers have been reported previously.

Methods: The 66-year-old lady suffered from left wrist crush injury. Painful sensation and swelling without superficial wound was noted. She went to local traditional Chinese medicine hospital for treatment. Lack of left thumb extension was noted after pain and swelling subsided. She came to our clinic 2 months after the injury. Ultrasonic examination showed EPL complete rupture and partial tear of EIP. Surgical reconstruction with tendon transfer was undertaken 2.5 months after injury. The patient had past history of Sjogren's syndrome with immunosuppression medication usage.

During surgery, EPL total rupture and EIP almost total rupture was noted at metacarpal bone level. EDC to small finger was very small and no small finger extension during traction of the EDC. Other donor tendon was not used due to the need of tendon graft and poor soft tissue condition of the patient under immunosuppression medication. We transferred ulnar half of EDM (for preserving extension function of small finger) to EPL using Pulvertaft technique. Splint protection for 3 weeks and rehabilitation program for 2 months were undertaken after the surgery.

Results: The patient received regular follow up at our clinic. The patient could extend her left thumb interphalangeal and metacarpophalangesl joints completely. The small finger extension function is intact. There were no complications during clinic follow up.

Conclusions: Half extensor digiti minim (EDM) transfer in a patient with traumatic loss of EPL is an alternative option for EPL reconstruction if no other potential tendon donors is suitable. After meticulous rehabilitation and regular follow up, the patient could have good thumb extension function recovery.