Case Overview

The video discusses the case presentation of a 50-year-old man with chronic ulnar dislocation of the right long finger central extensor tendon as a result of a radial-sided sagittal band rupture. The patient was indicated for dorsal tenodesis via extensor digitorum communis tendon transfer from the involved digit.

Method/Technique

Exposure is obtained via a radially based curvilinear incision centered over the metacarpal head. Subcutaneous dissection is continued down to the central extensor tendon. Because of the chronic nature of this condition, scar tissue should be débrided to fully expose the central extensor tendon of the involved digit. The tendon of the involved digit is then incised longitudinally to create a distally based, radial-sided flap for reconstruction. The strip of tendon is mobilized and tenodesed at the distal margin to prevent propagation of the split distally. The tendon is then passed beneath the intermetacarpal ligament in retrograde fashion. After carefully adjusting tension, the strip of tendon is tenodesed using a Pulvertaft weave and sutured back onto itself in horizontal mattress fashion. Next, the digit is brought through a range of motion to ensure the tendon is tracking centrally over the metacarpal head. The fibers of the ulnar sagittal band may be released to achieve central tracking.

Results

Our case series revealed elimination of pain and a low recurrence of tendon subluxation via this technique.

Summary

This technique is an excellent option for the late reconstruction of sagittal band rupture.