The surgical treatment of hand deformities in systemic lupus erythematosis

Ten patients with systemic lupus erythematosis hand deformities were studied. Wrist involvement included distal ulnar subluxation in 14 wrists (with four requiring excision) and various degrees of carpal instability in 12 wrists (usually asymptomatic). Metacarpophalangeal (MP) joint subluxation treated by soft tissue procedures for passively correctable deformities in 30 joints had a failure rate of 70%. MP joint arthroplasties performed in 33 joints gave fair results in 16 joints with fixed deformities and good results in 17 joints with passively correctable deformities. Thumb deformities always involved all three joints, and maintenance of carpometacarpal (CMC) joint stability was the key to thumb reconstruction. CMC joint stabilization with ligamentous reconstruction gave good results in three of four thumbs. Four CMC joint fusions and two CMC joint implant arthroplasties gave good results. Each was accompanied by appropriate procedures on the MP joint or interphalangeal joint.