Splintage in the treatment of sagittal band incompetence and extensor tendon subluxation

Peelman, J.; Markiewitz, Andrew D.; Kiefhaber, Thomas R.; Stern, Peter J.

doi:10.1177/1753193414530591

Cited by 18 publications

(7 citation statements)

References 11 publications

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“…Of these, 10 articles were excluded due to inclusion of less than 5 treated digits, 4 were review articles, 4 were descriptions of surgical techniques without any reported patient outcome data, 7 described treatment and outcomes for MCP capsular tears or collateral ligament injuries, and 1 included patients with rheumatoid arthritis. A total of 17 articles were included in the final systematic review and qualitative synthesis 1,3,5,[10][11][12][13][14][15][16][17][18][19][20][21][22][23] (Figure 1).…”

Section: Resultsmentioning

confidence: 99%

“…Four studies were single-center retrospective case series (Sackett level 4) with the defined inclusion and exclusion criteria, 13,14,17,22 and the remaining 13 were retrospective case reports (Sackett level 4). According to the SEQES scores, only 4 articles were considered to be of moderate quality (scores 17-32), 13,14,17,22 with the remaining being ranked as low-quality articles (scores 0-16). The mean SEQES score was 15 (range, 12-21), with no article achieving a high-quality rating (Figure 2).…”

Section: Study Selection Criteriamentioning

confidence: 99%

“…The literature search revealed 7 studies discussing nonoperative treatment of SB injuries, including 3 retrospective case series 14,17,22 and 4 retrospective case reports. 3,5,12,19 Rayan and Murray 5 described the treatment of acute SB injuries presenting within 3 weeks of injury with a palmar splint with the MCP joint in neutral position for type II or III injuries and Velcro buddy splinting for type I injuries.…”

Section: Nonoperative Managementmentioning

confidence: 99%

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

Masschelein

Suh

2020

Hand (New York, N,Y.)

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Background: This systematic review assesses the current literature and reviews the clinical outcomes of treatment for sagittal band injuries and extensor tendon instability. Materials: A systematic search of MEDLINE, EMBASE, and the Cochrane databases was performed for English-language articles on the treatment of nonrheumatoid adult sagittal band injuries between 1969 and 2019. Two independent reviewers were involved in screening, data extraction, and critical appraisal. The level of evidence was assigned using the Sackett scale, and the methodological quality of the studies was evaluated using the Structured Effectiveness Quality Evaluation Scale (SEQES). Outcome measures were persistent pain, extensor lag, and recurrent tendon subluxation. Results: In all, 1653 abstracts were identified, with 43 articles reviewed in full text and 17 articles (429 treated digits) included in the final systematic review. There were 10 studies on surgical management, 3 on nonoperative management, and 4 on both. There were 4 retrospective case series and 13 retrospective case reports (Sackett level 4) with an average SEQES score of 15 (low quality). Studies on nonoperative management had on average more digits per study and higher SEQES scores (n = 27.7, SEQES = 19) compared with studies on surgical management (n = 11.8, SEQES = 13.8). Variability in reported outcome measures precluded meta-analysis. Conclusion: Qualitative synthesis of available literature suggests that acute sagittal band injuries can be successfully treated by splinting the injured digit in neutral or hyperextension. Patients with chronic injuries or those failing nonoperative management may benefit from surgical exploration. A lack of consistent outcome measures precluded comparison of surgical techniques.

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Section: Resultsmentioning

confidence: 99%

Section: Study Selection Criteriamentioning

confidence: 99%

Section: Nonoperative Managementmentioning

confidence: 99%

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

Masschelein

Suh

2020

Hand (New York, N,Y.)

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“…Etiologically they are either traumatic or atraumatic. Chronologically Peelman et al 22 classified this pathology based on the time from onset of symptoms into acute (0 to 3 wk), subacute (3 to 6 wk), and chronic ( > 6 wk). Patients with acute injuries to the sagittal band are usually managed with extension splinting to allow primary healing of the extensor mechanism.…”

Section: Discussionmentioning

confidence: 99%

Anatomic Repair and Reconstruction of Radial Sagittal Band Ruptures

Kruger

Bain

2020

Techniques in Hand &Amp; Upper Extremity Surgery

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Two cases of traumatic sagittal band rupture causing extensor tendon subluxation are reported. A case of subacute rupture is repaired and a new surgical technique for reconstruction of a chronic rupture is described.Extensor tendon subluxation at the metacarpophalangeal joint is a rare occurrence in patients not affected by rheumatoid arthritis. The majority of cases involve the disruption of the radial sagittal band with consequent ulnar subluxation of the extensor tendon. The technique of sagittal band reconstruction described involves harvesting a distally based ulnar-sided strip of the extensor digitorum communis tendon, passing it transversely through the radial component of the tendon, and then looping it deep to the deep transverse metacarpal ligament. From here the tendon is then sutured back onto the central tendon, creating a delta-shaped graft. This technique reconstructs the normal anatomy of the sagittal band and has been found to eliminate the subluxation of the tendon and its associated pain.

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“…Recently Peelman et al reported satisfactory results with splintage in the treatment of acute and subacute extensor tendon subluxation due to sagittal band incompetence, with resolution in 95% of all traumatic cases. 64 For closed proximal interphalangeal joint injuries with central slip lesions, a splintage with extended joint for 6 weeks is commonly suggested. A Cochrane revision performed by Chalmer et al observed that there is insufficient evidence from trial testing about the duration and the extent of immobilization of proximal interphalangeal joint after hyperextension trauma.…”

Section: Overviewmentioning

confidence: 99%

Traumatic Extensor Tendon Injuries to the Hand: Clinical Anatomy, Biomechanics, and Surgical Procedure Review

Colzani¹,

Tos²,

Battiston

et al. 2016

J Hand Microsurg

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The extensor apparatus is a complex muscle-tendon system that requires integrity or optimal reconstruction to preserve hand function. Anatomical knowledge and the understanding of physiopathology of extensor tendons are essential for an accurate diagnosis of extensor tendon injuries (ETIs) of the hand and wrist, because these lesions are complex and commonly observed in clinical practice. A careful clinical history and assessment still remain the first step for the diagnosis, followed by US and MR to confirm the suspect of ETI or to investigate some doubtful conditions and rule out associate lesions. During last decades the evolution of surgical techniques and rehabilitative treatment protocol led to gradual improvement in clinical results of ETI treatment and surgical repair. Injury classification into anatomical zones and the evaluation of the characteristics of the lesions are considered key points to select the appropriate treatment for ETI. Both conservative and surgical management can be indicated in ETI, depending on the anatomical zone and on the characteristics of the injuries. As a general rule, an attempt of conservative treatment should be performed when the lesion is expected to have favorable result with nonoperative procedure. Many surgical techniques have been proposed over the time and with favorable results if the tendon injury is not underestimated and adequately treated. Despite recent research findings, a lack of evidence-based knowledge is still observed in surgical treatment and postoperative management of ETI. Further clinical and biomechanical investigations would be advisable to clarify this complex issue.

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Splintage in the treatment of sagittal band incompetence and extensor tendon subluxation

Abstract: Level 4.

Cited by 18 publications

References 11 publications

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

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

Anatomic Repair and Reconstruction of Radial Sagittal Band Ruptures

Traumatic Extensor Tendon Injuries to the Hand: Clinical Anatomy, Biomechanics, and Surgical Procedure Review

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