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Surgery of the Hand in Severe Systemic Sclerosis

From the Division of Orthopaedic Surgery, University of Toronto, St. Michael’s Hospital, Toronto, Ontario, Canada, Hôpital Orthopédique de la Suisse Romande, CHUV, University of Lausanne, Lausanne, Switzerland, Department of Medicine, Mount Sinai Hospital and Department of Surgery, Martin Family Centre for Arthritis Care and Research, Mobility Program, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada

Correspondence: Dr Earl R. Bogoch, 55 Queen St East, Suite 800, Toronto, Ontario, Canada M5C 1R6. Tel.: +1-416-864-5350; fax: +1-416-359-1601; E-mail: bogoche{at}smh.toronto.on.ca

Ten patients with scleroderma and severe hand problems required surgery, and seven were available for follow-up (two died from scleroderma-related complications and one was lost to follow-up). The mean duration of follow-up was 4 (range 1.5–9) years. Thirty-three procedures were carried out, including five metacarpophalangeal joint exisional arthroplasties, 13 proximal interphalangeal joint fusions, ten distal interphalangeal joint fusions, and one thumb interphalangeal joint fusion. The metacarpophalangeal joint excision arthroplasties and proximal interphalangeal joint fusions were performed for the correction of severe fixed "finger-in-palm" deformities. Lesions of cutaneous calcinosis were removed in four patients.

Fixation was satisfactory in all cases of interphalangeal joint fusion, with no cases of non-union. Wound healing was satisfactory in six of seven patients. A second surgical procedure was required in three patients for the removal of tension band wires following interphalangeal fusion. Calcinosis was effectively removed using a high-speed dental burr. The results of hand surgery for systemic sclerosis are reliable, but goals must be limited and patient expectations should be modest.

Key Words: arthrodesis • calcinosis • hand surgery • scleroderma • systemic sclerosis • wound healing

Journal of Hand Surgery (British and European Volume), Vol. 29, No. 6, 599-603 (2004)
DOI: 10.1016/J.JHSB.2004.03.013


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