The lupus hand: a new surgical approach

Three patients with lupus erythematosus developed severe hand deformities which, over the course of a year, went on to fixed volar subluxation of the proximal phalanges with some ulnar drift. The flexion deformity at the metacarpophalangeal joints of nearly 90 degrees was not correctable passively, and the palmar skin became macerated. The articular cartilage of the metacarpal heads and proximal phalanges was well preserved and replacement arthroplasty was not justified. Contracture not only in the intrinsics but also in the long flexors was not relieved by operation on the soft tissues. A step-cut metacarpal shortening did correct the remaining intrinsic and long flexor contracture, corrected the volar dislocation, restored full metacarpophalangeal extension, and maintained a full range of flexion. Position of the bones was maintained by intramedullary Steinmann pins and crossed Kirschner wires and, in one patient, by a small screw. No recurrences developed in the follow up period of 18 to 96 months.