Arch Hand Microsurg.  2022 Mar;27(1):41-48. 10.12790/ahm.21.0135.

Surgical treatment of sagittal band injuries and classification according to operative findings

• Lee KJ
• Song CH
• Kim JS
• Koh SH
• Lee DC
• Roh SY
• Park JH

• KMID: 2526647
• DOI: http://doi.org/10.12790/ahm.21.0135

Abstract

Purpose
The indications for surgery in patients with acute closed sagittal band injuries are still undetermined. The purpose of this study was to classify the types of injuries based on intraoperative findings of patients who underwent surgery for sagittal injuries, and to present the treatment plans and surgical methods.
Methods
Twenty-five patients who had undergone surgical exploration for closed sagittal band injuries between January 2011 and December 2020 were included in the study, comprising 17 patients with acute injuries (within 3 weeks), four patients with chronic injuries, and four patients who underwent surgery because symptoms did not improve in response to conservative treatment. Patients with laceration, fracture, and rheumatoid arthritis were excluded.
Results
Sagittal band injuries were classified into two groups: superficial sagittal band (SSB) and proper sagittal band (PSB) injuries. SSB injuries were observed in 75.0% of spontaneous rupture cases and PSB injuries were observed in 66.7% of traumatic rupture cases. SSB injuries were observed in 83.3% of Rayan and Murray classification type II cases and PSB injuries were observed in 61.5% of type III cases (p=0.041). PSB injuries were present in all four patients who underwent surgery because conservative treatment failed.
Conclusion
We successfully corrected sagittal band injuries with extensor digitorum communis tendon instability through surgical treatment. Sagittal band injuries can be classified into two types depending on the anatomical injury pattern; SSB and PSB injuries. The surgical method and treatment plan can be chosen based on this classification.

Keyword

Hand injuries; Metacarpophalangeal joint; Ligaments; Tendons; Operative surgical procedures

Figure

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  Fig. 1. Superficial sagittal band injury. (A) Tear of the superficial layer of the radial sagittal band is noted intraoperatively. With the metacarpophalangeal joint in an extended state, the extensor digitorum communis (EDC) tendon (asterisk) remains in place. (B) The forceps are holding the EDC tendon (asterisk). The EDC tendon is detached from the deep layer. The deep layers beneath the EDC tendon and the proper sagittal band (arrow) on the radial side are intact.

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  Fig. 2. Proper sagittal band (PSB) injury. (A) Complete rupture with gap formation on the ulnar side PSB (arrow) is noted intraoperatively. With the metacarpophalangeal joint flexed at approximately 15°, the gap widens and the extensor digitorum communis (EDC) tendon (asterisk) is displaced radially as a unit with the extensor hood. (B) The forceps are holding the thick PSB (arrow). The EDC tendon (asterisk) is completely covered by a superficial layer and a deep layer.

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  Fig. 3. (A) The superficial sagittal band injury is slightly and loosely repaired using a paratendon PDS 5-0 suture (Ethicon, Inc., Somerville, NJ, USA) at the border of the extensor digitorum communis tendon. (B) In a case of proper sagittal band (PSB) injury, the ruptured PSB is substantially repaired to prevent gap widening through the multiple figure-of-eight method and the consecutive method using PDS 4-0 and PDS 5-0 sutures.

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  Fig. 4. (A) Preoperative ultrasonography (USG) of a superficial sagittal band injury. Axial dynamic view of the third metacarpophalangeal (MP) joint during flexion shows hypoechoic thickening on the radial side of the extensor digitorum communis (EDC) tendon (asterisk). The EDC tendon is subluxed to the ulnar side. (B) Preoperative USG of a proper sagittal band (PSB) injury. Axial dynamic view of the third MP joint during flexion shows radial dislocation of the EDC tendon (asterisk). R, radial; U, ulnar.

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  Fig. 5. Treatment algorithm for sagittal band injuries. SSB, superficial sagittal band; PSB, proper sagittal band.

Reference

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