Crossed intrinsic transfer

A retrospective analysis of the long-term results of the crossed intrinsic transfer operation is presented. Twenty-one patients (30 hands) with rheumatoid arthritis and one patient (1 hand) with systemic lupus erythematosus were examined clinically and radiographically. The average follow-up was 12.7 years. The average postoperative ulnar drift for all fingers was 5 degrees. The magnitude of ulnar drift did not increase over time. The average active range of motion for the metacarpophalangeal joints was 47 degrees and for the proximal interphalangeal joints it was 58 degrees. The average radial deviation deformity of the wrist in the resting position was 2 degrees. These variables did deteriorate with time. Extensor carpi radialis longus to extensor carpi ulnaris tendon transfer with crossed intrinsic transfer produced the same result as crossed intrinsic transfer alone. The outcomes for crossed intrinsic transfer attached to the lateral band were similar to outcomes for transfers attached to the collateral ligament of the metacarpophalangeal joint. The crossed intrinsic transfer procedure effectively provides long-term correction of ulnar drift in the rheumatoid hand.