Fernández-Vázquez JM, Ayala-Gamboa U

Language: Spanish
References: 14
Page: 57-60
PDF size: 251.49 Kb.

ABSTRACT

Traumatic dislocation of the extensor tendon over the metacarpophalangeal (MCP) joint is a rare lesion that is caused by the dysfunction or rupture of the sagittal band, which is an important stabilizing structure of the extensor tendon. This mechanical alteration presents itself as instability that affects function and may cause pain or snapping during finger motion. The diagnosis is made when ulnar dislocation of the extensor tendon is observed over the MCP joint. Nonsurgical treatment is successful and should be attempted when injuries are diagnosed within the first three weeks. Several surgical repairs have been described. Material and methods: We searched medical databases (Ovid, Medline) for papers on extensor tendon dislocation. We also revised our own cases of this injury. Results: Our search resulted in 10 articles and four books. We found 18 patients with 21 injuries, 10 men and eight women. The most frequently affected finger was the middle one (in thirteen cases), followed by the index (in five cases), the fourth finger (in two cases) and the third one (in one case). Eight of our patients were treated conservatively and thirteen required surgical treatment. The surgical procedures performed were Wheeldon’s in seven cases; primary repair of the sagittal band and Wheeldon in four cases; primary repair alone in one case; and Carroll’s in one case. The follow-up was between one and 34 years (average: 17.5 years). Discussion: Extensor tendon dislocation in zone V is rare. When the diagnosis is made after three weeks of the lesion, the surgical treatment is recommended.

REFERENCES

1. Green DP: Green’s operative hand surgery. 5th edition. New York, USA: Elsevier Inc. Traducido en Madrid, España, por Marbán Libros SL; 2007: 207-12.

2. Strickland J: Técnicas en cirugía ortopédica. Mano. 2.a edición. Madrid. Marbán; 2004: 277-84.

3. Tubiana R, Valentin P. The anatomy of the extensor apparatus of the fingers. Surg Clin North Am. 1964; 44: 897-906.

4. Zancolli E: Structural and dynamic bases of hand surgery. Philadelphia: JB Lippincott; 1979: 325-60.

5. Kettelkamp DB, Flatt AE, Moulds R: Traumatic dislocation of the long-finger extensor tendon. A clinical, anatomical, and biomechanical study. J Bone Joint Surg Am. 1971; 53(2): 229-40.

6. Bin Iftikhar T, Hallmann BW, Kaminski RS, Ray AK: Spontaneous rupture of the extensor mechanism causing ulnar dislocation of the long extensor tendon of the long finger. Two case reports. J Bone Joint Surg Am. 1984; 66(7): 1108-9.

7. Ishizuki M: Traumatic and spontaneous dislocation of extensor tendon of the long finger. J Hand Surg Am. 1990; 15(6): 967-72.

8. Ferlemann K, Zilch H: Closed injuries of the extensor hood of the metacarpophalangeal joint Unfallchirurgie. 1997; 23(6): 262-6.

9. Le Viet D, Ebelin M, Loy S: Traumatic luxation of the extensor apparatus of the dorsum of the metacarpophalangeal joint of the little finger. Six cases. Ann Chir Main Memb Super. 1991; 10(4): 273-9.

10. Rayan GM, Murray D, Chung KW, Rohrer M: The extensor retinacular system at the metacarpophalangeal joint. Anatomical and histological study. J Hand Surg Br. 1997; 22(5): 585-90.

11. De Smet L, Heirweg S, Vandesande W: Traumatic divergent dislocation of the extensor tendons over the metacarpophalangeal joint. J Orthop Trauma. 2002; 16(3): 207-9.

12. Inoue G, Tamura Y: Dislocation of the extensor tendons over the metacarpophalangeal joints. J Hand Surg Am. 1996; 21(3): 464-9.

13. Elson RA: Dislocation of the extensor tendons of the hand. J Bone Joint Surg. 1967; 49B: 324-6.

14. McCoy FJ, Winsky AJ: Lumbrical loop operation for luxation of the extensor tendons of the hand. Plast Reconstr Surg. 1969; 44: 142-6.