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Outcomes of metacarpophalangeal capsulectomy for extension contracture
Christian M Shigley, MD
1; Annie M. Squires, BA candidate
1; Chelsea Boe, MD
1; Jerry Iming Huang, MD
21University of Washington, Seattle, WA; 2Department of Orthopaedic Surgery, University of Washington, Seattle, WA
Introduction: Metacarpophalangeal (MCP) stiffness is common following hand trauma and frequently results in MCP extension contractures, with loss of flexion. For patients who have failed therapy with range of motion exercises and splinting, dorsal metacarpophalangeal (MCP) capsulectomy can be effectively in improving MCP joint flexion.
Methods: Chart review was performed on all patients treated from 2012-2022 at our institution who had undergone dorsal MCP capsulectomy for extension contracture following MCP trauma. Our cohort included patients with metacarpal or phalangeal fractures and patients with extensor tendon injuries in zones 4-6. We excluded thumbs and digit replants as well as patients with prior tendon transfers or reconstructions. Range of motion and pain scores at final follow-up were collected. Complications including tendon rupture, infection, and reoperations were reviewed.
Results: There were 62 digits that met our inclusion criteria. Of the 62 digits, 36 underwent concomitant extensor tenolysis. There was adequate follow-up of 42/62 digits. MCP joint flexion improved from 34 degrees preoperatively to 55 degrees at final follow-up. There was improvement in MCP joint extension from 6.3 degrees pre-operatively to 2.4 degrees extension at final follow-up. Revision extensor tenolysis was performed in 13 digits. There were no tendon ruptures, no infections and no digital nerve injuries, though subjective dysesthesias were reported in 2 digits. One digit was associated with post-operative hematoma. Four digits experienced worse motion following MCP capsulectomy and tenolysis and one underwent elective ray amputation.
Conclusion: MCP extension contractures are a common problem following tendon or bony trauma at the level of the MCP joint which can be treated surgically with MCP capsulectomies. This study demonstrates that dorsal MCP capsulectomies combined with extensor tenolysis can provide a modest improvement in MCP joint flexion. 10% of our patients had a worse outcome with 1 patient electing to undergo ray amputation. Expectations for functional improvement in motion should be appropriately tempered in this patient population
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