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Journal of Hand Surgery (European Volume)
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Articles

A Split-EPB Tendon Sling for Chronic Post-Traumatic Palmar Instability of the Thumb Metacarpophalangeal Joint

G. J. S. LIM
A. YAM
S. C. TAY
F. C. YONG
L. C. TEOH

From the Department of Hand Surgery, Singapore General Hospital, Outram Road, Singapore

Correspondence: Mr Andrew Yam, MRCSEd, Department of Hand Surgery, Singapore General Hospital, Outram Road, Singapore 169608, Singapore. Tel.: +656321 4588; fax: +656227 3573., E-mail:jediyam{at}yahoo.com.sg.

Kessler’s extensor pollicis brevis (EPB) palmar tendon sling is a simple and reliable reconstruction for symptomatic palmar instability of the thumb metacarpophalangeal (MP) joint. However, we encountered subluxation of the extensor pollicis longus tendon and extension lag at the MP joint when the entire tendon was used. We modified the technique, splitting the tendon to preserve its function as an MP joint extensor. Six thumb MP joints with anteroposterior instability secondary to hyperextension injury were reconstructed using the split-EPB technique. At an average of 22 months postoperatively, all patients had stable and pain-free MP joints. Pinch strength improved an average of 5.6 kg. MP joint flexion was decreased an average of 17.5° and two patients had flexion contractures of 5° and 20°, respectively. Extensor pollicis longus subluxation and MP extension lag did not occur, and there were no recurrences.

Key Words: split-EPB tendon sling • thumb metacarpophalangeal joint • volar instability • post-traumatic

Journal of Hand Surgery (European Volume), Vol. 34, No. 3, 358-362 (2009)
DOI: 10.1177/1753193408097320
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