Tendon graft reconstruction of extensor hood deficits with subluxation

Abstract

Injuries to the radial or ulnar sagittal bands at the metacarpophalangeal (MP) joint may result from open or closed injuries to the dorsum of the hand. Closed avulsion injuries may occur as a result of a direct blow or from forced flexion or extension to the MP joint. Typically, the radial sagittal bands are involved and the central slip subluxes ulnarly into the adjacent groove. If the deficit is severe, the central slip remains in the trough, severely compromising the ability to extend the MP joint. In addition, ulnar deviation of the digit may result, and overpull of the central slip may cause a swan neck deformity. In most cases there is sufficient adjacent tendon material to repair and reconstruct the defect. If it cannot be repaired reliably primarily,' then juncturae tendinum 2 or segments of the extensor hood 3 can be threaded to an adjacent radial collateral ligament or lumbrical tendon to shift the vector forces about the central slip tendon so that it glides centrally. The following is a technique for the centralization of the extrinsic extensor tendon in those cases in which no sagittal band exists on either the radial or ulnar side and no juncturae exists nearby, and the quality of the tendon itself is questionable so that dividing it would attenuate it unnecessarily.