[Palliative operations for correction of claw fingers]

Area of Science:

• Orthopedic Surgery
• Hand Surgery
• Reconstructive Surgery

Background:

• Palsy of intrinsic hand muscles classically targets claw suppression.
• Functional restoration requires re-establishing volar flexion for prehension.
• Surgical interventions for intrinsic hand palsy have varied techniques with distinct advantages and drawbacks.

Purpose of the Study:

• To evaluate surgical interventions for intrinsic hand muscle palsy.
• To introduce a metacarpophalangeal stabilization test for guiding surgical technique selection.
• To correlate residual finger stiffness with appropriate surgical options.

Main Methods:

• Review of 337 operated hands with intrinsic muscle palsy.
• Classification of surgical techniques based on finger stiffness (loose, stiff, very stiff PIP joint).
• Introduction and application of the metacarpophalangeal stabilization test to assess proximal interphalangeal joint stiffness.

Main Results:

• The metacarpophalangeal stabilization test effectively indicates the degree of proximal interphalangeal joint stiffness.
• Specific surgical interventions are recommended based on the degree of PIP joint stiffness.
• Techniques include MP capsular shortening, flexor digitorum superficialis (FDS) tendon transfers (Lasso, Bunnell-Litter), and tendon grafts (Giraudeau, Brand, Palande).

Conclusions:

• The metacarpophalangeal stabilization test simplifies surgical decision-making for intrinsic hand palsy.
• Treatment selection is primarily guided by the degree of proximal interphalangeal joint stiffness.
• Arthrodesis is indicated for very stiff PIP joints ( >90 degrees flexion).