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The Treatment Of Ruptures Of Multiple Extensor Tendons At Wrist Level By Using Each Reversed Extensor Digitorum Communis (Edc) Half-Slip Tendons Of Proximal Stump In The Rheumatoid Hand
Hirokazu Tochigi, MD1; Okuyama Kunimasa, MD1; Takeru Arai, MD, PhD2
1Shizuoka City Shimizu Hospital, Shizuoka, Japan; 2Tokyo Dental Ichikawa General Hospital, Ichikawa, Japan

Introduction: In rheumatoid arthritis (RA), rupture of extensor tendons often occurs in multiple fingers. Direct repair was usually impossible because of retraction, shortening of the muscle. However, we tried to reduce the tendon gap and repair directly by using each reversed EDC half-slip tendons of proximal stump. In this study, we evaluated our surgical repair outcome.
Material and Methods: Of 4 RA patients (3 females, 1 male) who underwent surgery for total EDC tendon ruptures between 2012 and 2015. The mean age at surgery was 67 years (range, 59 to 71). The mean period from symptom of total drop fingers to surgery was 58days (range, 29 to 97).The mean follow-up period after the surgery was 2.0 years (range, 1 to 3). Our treatment consisted of synovectomy, wrist arthroplasy by Sauve-Kapandi’s procedure, tendon end-to-end interlacing suture using each reversed 5cm EDC half-slip tendons of proximal stump, and repaired tendon was sutured side-to-side each other. Active exercise of the fingers was started immediately after the surgery. Surgical outcomes were evaluated on the basis of patient’s satisfaction and the range of motion (ROM) of the MP joint and wrist.
Results: Three patients (75%) were highly satisfied and one (25%) was satisfied with surgical outcomes. The mean MP joint active extension was 1.7°(range , 0 to 5). The mean MP joint active flexion 78.3°(range, 65 to 83). In all cases, wrist flexion ROM was limited more than 15°compare to non-surgical wrist, but no one complained of activity of daily living(ADL) disturbance.
Conclusions: For multiple extensor tendon ruptures of rheumatoid hand, our tendon reconstruction procedure led to almost full finger extension function without damage of other intact tendon and active finger ROM exercise could start soon after surgery.Full finger flexion also obtained in all cases. Although limitation of wrist flexion ROM were observed, no one complained of ADL disturbance.


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