The centralization of extensor tendons during wrist surgery.

Area of Science:

• Orthopedic Surgery
• Rheumatology
• Hand Surgery

Background:

• Rheumatoid arthritis (RA) commonly affects the wrist, often requiring surgical intervention.
• Post-operative extensor tendon subluxation (ulnar shift) is a known complication after wrist surgery in RA patients.
• This complication results from dorsal tenosynovectomy, extensor retinaculum disruption, and altered tendon anatomy.

Purpose of the Study:

• To describe an adjunctive surgical technique to prevent or correct ulnar subluxation of extensor tendons.
• To stabilize and centralize the tendons of the fourth dorsal wrist compartment over the wrist's midline.

Main Methods:

• A distally based sling is created from the extensor carpi radialis longus (ECRL) tendon.
• This sling is wrapped around the extensor digitorum communis (EDC) and extensor indicis proprius (EIP) tendons.
• The sling is then anchored to the extensor carpi radialis brevis (ECRB) tendon to secure centralization.

Main Results:

• The described technique effectively stabilizes and centralizes the tendons of the fourth dorsal wrist compartment.
• This method provides a reliable adjunct for managing extensor tendon subluxation, particularly after wrist arthroplasty.

Conclusions:

• This tendon sling technique is a valuable addition to wrist surgery for RA patients prone to extensor tendon ulnarization.
• It addresses a specific post-operative complication, aiming to improve functional outcomes and prevent further tendon issues.