The centralization of extensor tendons during wrist surgery

After a wrist surgery in patients with rheumatoid arthritis, the extensor tendons have a tendency to shift toward the ulnar side of the wrist. This is caused by the dorsal tenosynovectomy, disruption of extensor retinaculum, and exteriorization and anatomical orientation of the superficial group of forearm extensor tendons. This article describes a technique as an adjunct to the wrist surgery, which aims to stabilize and centralize tendons of the fourth dorsal wrist compartment over the midline of the wrist. This is achieved by creating a distally based sling, harvested from the extensor carpi radialis longus tendon, then wrapped around the extensor digitorum communis and the extensor indicis proprius tendons, and finally anchored onto the extensor carpi radialis brevis. This adjunctive procedure is recommended in situations when after the wrist surgery, particularly wrist arthroplasty, tendons of the fourth dorsal wrist compartment tend to lay ulnar to the central axis of the hand.