The extensor apparatus in Dupuytren's disease.

If we study the secondary changes in the extensor mechanism we can see changes at each of the three joint levels which are responsible for incomplete correction of the deformity after apparently adequate surgery on the palmar aspect. At the DIP level the flexion may not be restored until tenotomy of this secondarily contracted extensor tendon is performed. At the PIP level the middle slip may be used as a "lively splint" capable of progressive post-operative straightening of this joint if tenotomy over the middle phalanx is used. At the MP joint of the little finger ulnar subluxation of the extensor tendons may produce persistent MP flexion although passively correctable, and relocation of the extensors at this level may occasionally be indicated to correct this persisting disability.