Complications of opponensplasty with transfer of extensor carpi ulnaris to extensor pollicis brevis

The extensor carpi ulnaris (ECU) was transferred to the extensor pollicis brevis, as described by Phalen and Miller, in 12 patients with hand deformities from high and low median and ulnar nerve injuries. Although no complications of this transfer have been reported by other surgeons, four of our 12 patients developed significant radial deviation and loss of power grip. This complication was corrected in two patients by transferring the extensor carpi radialis longus to the base of the fifth metacarpal to balance the wrist extensor forces. We believe that this complication may occur when the extensor carpi radialis inserts into the radial aspect of the second metacarpal and when the ECU inserts into the ulnar aspect of the base of the fifth metacarpal. The flexor carpi ulnaris must have normal strength if the wrist is to be balanced after the ECU is transferred.