P Schaller1, W Baer. 1. Klinik für Handchirurgie und Plastische Chirurgie, Kliniken Dr. Erler gGmbH, Nürnberg. p.schaller@erler-klinik.de
Abstract
BACKGROUND: Secondary reconstruction of the extensor pollicis longus tendon (EPL) can be performed using an intercalated tendon graft (ITG) or a tendon transposition, preferably the extensor indicis transposition (EIT), since a secondary suture of the EPL tendon is not possible in most cases due to degenerative changes or defect injuries. A direct comparison of ITG and EIT in one single patient collective based on a standardized follow-up protocol has not been performed yet. PATIENTS AND METHOD: For the first time, these two operative procedures were directly compared in a retrospective analysis according to the follow-up protocol after Geldmacher et al. an average of 4.3 (2 to 11) years after reconstructive surgery. Out of 1469 extensor tendon lesions only 55 patients were identified in the course of secondary reconstruction of the EPL tendon in whom additional injuries, especially osseous lesions or other conditions that affected the mobility of the thumb, could be ruled out reliably. 45 (82 %) of these patients participated in a clinical follow-up examination. In 28 (62 %) patients an EIT and in 17 (38 %) an ITG was performed. RESULTS: Neither the range of motion in the metacarpophalangeal and interphalangeal joint of the thumb, the abduction and the adduction of the thumb as well as the extension deficit and the remaining pulp-to-pulp distance during thumb opposition, compared to the contralateral hand, nor the overall evaluation showed a significant difference (Students-t-test; p < 0.05) between the results of both procedures. CONCLUSION: The EIT and the ITG for the secondary reconstruction of the EPL tendon should be regarded as equal alternatives.
BACKGROUND: Secondary reconstruction of the extensor pollicis longus tendon (EPL) can be performed using an intercalated tendon graft (ITG) or a tendon transposition, preferably the extensor indicis transposition (EIT), since a secondary suture of the EPL tendon is not possible in most cases due to degenerative changes or defect injuries. A direct comparison of ITG and EIT in one single patient collective based on a standardized follow-up protocol has not been performed yet. PATIENTS AND METHOD: For the first time, these two operative procedures were directly compared in a retrospective analysis according to the follow-up protocol after Geldmacher et al. an average of 4.3 (2 to 11) years after reconstructive surgery. Out of 1469 extensor tendon lesions only 55 patients were identified in the course of secondary reconstruction of the EPL tendon in whom additional injuries, especially osseous lesions or other conditions that affected the mobility of the thumb, could be ruled out reliably. 45 (82 %) of these patients participated in a clinical follow-up examination. In 28 (62 %) patients an EIT and in 17 (38 %) an ITG was performed. RESULTS: Neither the range of motion in the metacarpophalangeal and interphalangeal joint of the thumb, the abduction and the adduction of the thumb as well as the extension deficit and the remaining pulp-to-pulp distance during thumb opposition, compared to the contralateral hand, nor the overall evaluation showed a significant difference (Students-t-test; p < 0.05) between the results of both procedures. CONCLUSION: The EIT and the ITG for the secondary reconstruction of the EPL tendon should be regarded as equal alternatives.
Authors: Markus Figl; Michael Mayer; Stefan Lederer; Robert Bogner; Martin Leixnering Journal: Wien Klin Wochenschr Date: 2011-08-03 Impact factor: 1.704