A new technique in surgical treatment of congenital and spontaneous extensor tendon snapping: Dorsalization-ulnarization of the metacarpal head.

The present study reports results of a metacarpal transposition technique we have developed for congenital and spontaneous extensor tendon snapping. Six patients with a mean age of 14 years (range: 12-19 years) were included and evaluated retrospectively. They had Rayan-Murray type-3 atraumatic chronic extensor tendon instability: 2 on the middle finger, 3 on the ring finger, and 1 on the index and middle fingers. In selecting the cases, preoperative examination included elevation of the metacarpals to check whether this decreased the tendon snapping, and patients in whom no snapping persisted were scheduled for surgery. Pre- and post-operative pain at rest and in activity was assessed on visual analog scale (VAS), and the QuickDASH test was administered. Pre- and post-operative active and passive ranges of metacarpophalangeal motion were measured, as was grip strength on a Jamar dynamometer. Mean follow-up was 38 months (range: 26-42 months). Postoperatively, pain during activity and QuickDASH score showed significant improvement. No wound problems or recurrence were encountered. There were no significant postoperative changes in active and passive joint range of motion. At follow-up examination, no physical therapy needed to be prescribed and no limitation of motion was observed. For tendon snapping, in which treatment is technically difficult and may lead to problems, we believe that our easily applicable minimally traumatizing technique does not restrict joint motion and is an appropriate solution for patients with positive elevation test.