Treatment of Sagittal Band Injuries and Extensor Tendon Subluxation: A Systematic Review

Area of Science:

• Orthopedics
• Hand Surgery
• Sports Medicine

Background:

• Sagittal band injuries and extensor tendon instability are common in adults.
• Treatment outcomes for these conditions are not well-established.
• A systematic review is needed to synthesize current evidence.

Purpose of the Study:

• To systematically review the literature on clinical outcomes of treatments for sagittal band injuries and extensor tendon instability.
• To evaluate the effectiveness of operative and nonoperative management strategies.
• To identify gaps in the current research.

Main Methods:

• Systematic search of MEDLINE, EMBASE, and Cochrane databases (1969-2019).
• Inclusion of English-language articles on nonrheumatoid adult sagittal band injuries.
• Data extraction and critical appraisal by two independent reviewers using Sackett scale and SEQES.

Main Results:

• 17 articles (429 digits) were included, with 10 on surgical and 3 on nonoperative management.
• Studies were primarily retrospective case series/reports (Sackett level 4) with low methodological quality (average SEQES=15).
• Nonoperative management studies had higher SEQES scores and more digits than surgical studies.

Conclusions:

• Acute sagittal band injuries may be successfully treated with splinting in neutral or hyperextension.
• Surgical exploration may benefit patients with chronic injuries or those failing nonoperative treatment.
• Inconsistent outcome measures prevent comparison of surgical techniques.