Radiologic evaluation of the rheumatoid hand after synovectomy and extensor carpi radialis longus transfer to extensor carpi ulnaris
Purpose: In this study we radiologically evaluated the effects of extensor carpi radialis longus (ECRL) tendon transfer on the stability and deformity of joints of rheumatoid hands in cases with a postoperative period of more than 5 years. Methods: Synovectomy concomitant with tendon transfer of the ECRL to the extensor carpi ulnaris (Clayton's procedure) was performed in 28 wrists of 23 patients with rheumatoid arthritis. The follow-up period was 8.8 ± 2.8 years. Pre- and postoperative x-rays were reviewed and measured. Follow-up evaluation included Steinbrocker's classification of the radiocarpal joints, Larsen's grade of the third metacarpophalangeal (MCP) joint, radial angulation of the wrist, ulnar translocation of the carpus, and ulnar drift of the fingers. Results: Nineteen of 28 wrists (68%) were ankylosed (radius-proximal carpal row fusion or radiolunate limited fusion). Radial angulation of the wrist was reduced from 131° ± 8.8° before surgery to 121° ± 7.9° after surgery. Dislocation and ulnar translocation of the carpus (UTC) were prevented by surgery (UTC: 1.05 ± 0.10 before and 1.07 ± 0.09 after surgery). The mean ulnar drift of the fingers was maintained at the preoperative level (UDF: 14° ± 5.7° before and 14° ± 12.9° after surgery). The incidence of alteration (increase and decrease) of UDF of more than 5° between pre- and postoperative evaluation was significantly higher in the group with worsening of Larsen grade of MCP joints than in the group without worsening (with worsening: 7 of 8 MCP joints, without worsening: 8 of 20 MCP joints). Conclusions: ECRL tendon transfer (Clayton's procedure) provided effective stabilization at more than 5 years (mean, 8.8 y) after surgery. In addition, this method may help to prevent ulnar drift of the fingers if combined with correction of local factors at the MCP joints. Copyright © 2003 by the American Society for Surgery of the Hand.