J Korean Orthop Assoc.  2017 Jun;52(3):212-218. 10.4055/jkoa.2017.52.3.212.

A Repair of Sagittal Band for Subluxation of the Extensor Tendons at the Metacarpophalangeal Joint

• Lee HJ
• Lee JK
• Kim JW
• Kim TS
• Oh CH
• Han SH

• KMID: 2384550
• DOI: http://doi.org/10.4055/jkoa.2017.52.3.212

Abstract

PURPOSE
Subluxation of the extensor tendon that result from sagittal band injury at the metacarpophalangeal (MCP) joint can lead to joint pain and limit the range of motion in fingers. Upon the injury mechanism, other causes except rheumatoid arthritis are relatively uncommon, and studies regarding the operative management are also sparse. We performed a direct repair of sagittal band and attempted to report clinical results of our experience in patients without application of conservative management.
MATERIALS AND METHODS
Authors retrospectively reviewed the medical records of 26 patients who underwent operative treatment for extensor tendon subluxation. There were 23 males and 3 females with the mean age of 39.9 years old. All patients had an injury on the long finger, and presenting an ulnarward extensor tendon subluxation. Nine patients were injured from the direct blow, 14 patients from the flicking finger, and 3 patients from the resisted finger flexion. The mean time interval between the injury and operation was 27.5 days. The mean duration of follow-up was 14.6 months. As clinical results, authors evaluated visual analogue scale, MCP joint range of motion, total active motion (TAM), 3rd finger tip pinch power, and recurrence of extensor tendon.
RESULTS
The mean final MCP joint flexion was 89.6° with 22.8° of extension. The mean TAM was 248° without a significant difference between opposite hands. The mean tip-pinch power was 3.4 kg (7.5 lb), which also did not have any significant difference with contralateral hand. Herein, we did not experience subluxation recurrence, and all but one was pain-free at the final outpatient clinic follow-up.
CONCLUSION
A direct repair of the sagittal band for the extensor tendon subluxation presented a favorable clinical outcome. Therefore, we can suggest that such a method can be a treatment option for patients not undergoing conservative management.

Keyword

sagittal band; extensor tendon; subluxation; sagittal band repair

MeSH Terms

Ambulatory Care Facilities
Arthralgia
Arthritis, Rheumatoid
Female
Fingers
Follow-Up Studies
Hand
Humans
Joints
Male
Medical Records
Metacarpophalangeal Joint*
Methods
Range of Motion, Articular
Recurrence
Retrospective Studies
Tendons*

Figure

• 

  Figure 1 (A, B) Dorsal metacarpophalangeal joint exposure after a longitudinal curved skin incision and subcutaneous dissection. The sagittal band was ruptured and ulnarward subluxation of the 3rd extensor tendon was identified. (C, D) Using continuous interlocking suture technique, the sagittal band was re-attached to the lateral side of the extensor tendon. (E) Two continuous interlocking sutures were conducted in opposite directions, one went from proximal to distal, and vice versa the other one. (F) The common extensor digitorum tendon was located at the center when the surgeon finished the sagittal band repair.

• 

  Figure 2 (A) Experimental group of total active motion (248°) did not show a significant difference with the control group (250°) (p=0.126). (B) Pinch power of patients (3.4 kg; 7.5 lb) did not show a significant difference with the control group (3.3 kg; 7.3 lb) (p=0.292).

• 

  Figure 3 (A, B) A 28-year-old male with flicking injury presented ulnar subluxation of the extensor tendon at his right 3rd metacarpophalangeal joint (MPJ). (C, D) Clinical photos of 46 months after the operation presented the right 3rd extensor digitorum communis tendon maintaining in the central position over the MPJ. The patient recovered a full range of motion, extension 15° and 90° flexion.

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