Simultaneous four finger metacarpophalangeal joint fusions - indications and results

To review the results and indications of simultaneous four finger metacarpophalangeal joint fusions.

The clinical records and X-rays of nine patients undergoing the above procedure were reviewed. The indication for surgery was to reverse severe metacarpophalangeal joint flexion deformities in eight patients, and following a traumatic four finger amputation in one. Seven patients returned for follow-up assessment. The fusions were performed with a tension band wire technique, aiming for 20 degrees of flexion for index and middle fingers and 40 degrees in the ring and little fingers. Time to radiological fusion and position of fusion, and improvement in function and appearance were assessed.

All joints were radiologically fused between six and 12 weeks. The average position of fusion of index and middle fingers was 20 degrees (range: 15-30) and ring and little fingers was 40 degrees (range: 35-50). Appearance was improved in all patients. Improved function was reported by four patients, and improved ease of hygiene and general care in four patients with non-functioning or poorly functioning hands.

Simultaneous fusion of all four finger metacarpophalangeal joints may be considered as a primary procedure to reconstruct destroyed metacarpophalangeal joints due to inflammatory arthropathy or trauma, and for inability to correct deformity or maintain the correction with soft tissue procedures for patients with cerebral palsy, adult brain injury and arthrogryposis.