The lupus hand: a new surgical approach.

Area of Science:

• Rheumatology
• Orthopedic Surgery
• Hand Surgery

Background:

• Lupus erythematosus can cause severe hand deformities, including fixed flexion contractures and volar subluxation.
• These deformities significantly impair hand function and can lead to skin maceration.
• Previous treatments like soft tissue operations were insufficient for these complex cases.

Purpose of the Study:

• To evaluate the efficacy of a novel surgical technique for correcting severe hand deformities in patients with lupus erythematosus.
• To assess the long-term outcomes of metacarpal shortening in restoring hand function and joint stability.

Main Methods:

• A step-cut metacarpal shortening procedure was performed on three patients with lupus-induced hand deformities.
• Internal fixation using intramedullary Steinmann pins, Kirschner wires, and a screw was employed.
• Postoperative follow-up ranged from 18 to 96 months.

Main Results:

• The surgical intervention successfully corrected intrinsic and long flexor contractures.
• Volar dislocation was rectified, and full metacarpophalangeal extension and flexion were restored.
• No recurrences of deformities were observed during the follow-up period.

Conclusions:

• Metacarpal shortening is a viable and effective surgical option for correcting severe, fixed hand deformities in lupus erythematosus patients.
• This technique offers a durable solution, improving both joint stability and functional range of motion.
• The preserved articular cartilage supported the decision against joint replacement, highlighting the benefits of bone-altering procedures.