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

A Novel Procedure for Chronic Sagittal Band Rupture, Permitting Immediate Active Motion and Hand Use During Recovery

Meeting Abstract

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  • presenting/speaker Wyndell Merritt - VCU/MCV, UVA, Henrico, United States
  • Lauren Nigro - VCU/MCV, Richmond, United States

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. DocIFSSH19-1025

doi: 10.3205/19ifssh1072, urn:nbn:de:0183-19ifssh10727

Published: February 6, 2020

© 2020 Merritt 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

Text

Objectives/Interrogation: Chronic sagittal band ruptures have characteristically been treated by surgical techniques that repair or reinforce the ruptured side to ipsilateral structures, then immobilize in extension 6-10 weeks, followed by an intense course of therapy. Cause of deformity can be traumatic or due to connective tissue weakness, as in Ehlers-Danlos syndrome (EDS) or connective tissue disease. This report supports use of a strong tendon graft centralization and relative motion extension (RME) splinting to preserve motion and function during healing, obviating the need for additional therapy.

Methods: 23 years ago we encountered a rheumatoid arthritis patient who after repeated steroid injections subluxed on both sides of her MP joint. The EDC tendon was centralized by a tendon graft passed through the metacarpal head, then RME utilized for 6 weeks to protect the repair and permit active motion. The result encouraged us to similarly manage the following 22 patients reported, most of whom had traumatic rupture, one with EDS and 3 with rheumatoid arthritis. Tendon grafts have been used from juncturae tendinum, extensor retinaculum, half of the EIP, have of the EFR and most recently the palmaris longus tendon.

Results and Conclusions: These patients were encouraged to resume normal hand function in the splint, and recovered full range of motion without need for additional therapy. The only failure was in a rheumatoid patient with ulnar deviation of her 4th and 5th digits that remained uncorrected by centralization. This surgical technique obviates the need for careful tension adjustment to centralize the tendon, and provides a strong pulley to support patients whose connective tissue strength may be questionable. The use of safe, active motion in an RME orthosis preserves function and avoids need for a prolonged therapy program.