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Crossed intrinsic transfer.

L H Oster1, W F Blair, C M Steyers

  • 1Department of Orthopaedics, University of Iowa, Iowa City 52242.

The Journal of Hand Surgery
|November 1, 1989
PubMed
Summary
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The crossed intrinsic transfer effectively corrects long-term ulnar drift in rheumatoid arthritis hands. This surgical procedure shows lasting benefits for rheumatoid arthritis patients, improving hand function and alignment over many years.

Area of Science:

  • Orthopedics
  • Rheumatology
  • Hand Surgery

Background:

  • Rheumatoid arthritis commonly causes ulnar drift and metacarpophalangeal joint deformities.
  • Surgical interventions are often necessary to restore hand function and correct deformities.

Purpose of the Study:

  • To evaluate the long-term efficacy of the crossed intrinsic transfer procedure for correcting ulnar drift in patients with rheumatoid arthritis.
  • To assess the impact of the procedure on joint mobility and wrist deformity over an extended follow-up period.

Main Methods:

  • Retrospective analysis of 21 patients (30 hands) with rheumatoid arthritis and 1 patient (1 hand) with systemic lupus erythematosus.
  • Clinical and radiographic examinations were performed with an average follow-up of 12.7 years.
  • Comparison of outcomes between crossed intrinsic transfer alone and combined with extensor carpi radialis longus to extensor carpi ulnaris tendon transfer.

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Main Results:

  • The average postoperative ulnar drift was 5 degrees and did not increase over time.
  • Average active range of motion was 47 degrees for metacarpophalangeal joints and 58 degrees for proximal interphalangeal joints.
  • Wrist radial deviation deformity averaged 2 degrees and showed deterioration over time.

Conclusions:

  • The crossed intrinsic transfer procedure provides effective, long-term correction of ulnar drift in the rheumatoid hand.
  • The procedure's effectiveness is comparable regardless of attachment site (lateral band or collateral ligament) or combination with other tendon transfers.