[An original technique for stabilizing the metacarpopharyngeal joints of the ulnar hand: "The transosseous capsuloplasty with anterior-posterior drilling"].
In reconstructive surgery of the ulnar clawhand deformity, the metacarpophalangeal joints of the digits and the thumb must be stabilised. The "capsuloplasty with anteroposterior drilling", which is described in this paper is an original technique whose first goal is to make this stabilisation easier and with an effectiveness at least equal to the classic and difficult Zancolli techniques. It consists, after a longitudinal opening of the volar plate, of drilling an anteroposterior hole at the level of the metacarpal neck using a square point awl, a small dorsal incision allowing protection of the extensor tendons. A needle with a non absorbable thread takes the first half of the palmar plate, goes through the hole and is brought out on the dorsal aspect of the hand, then a Halsted forceps is passed keeping close to the metacarpal neck to bring the needle to the palmar side and finally take the second half of the palmar plate. The knots are tied with the metacarpophalangeal joints in 25 degrees flexion. From June 1997 to April 2001, 25 patients suffering from ulnar nerve palsy and ten patients suffering from combined ulnar and median nerve palsy have benefited from this technique to correct the clawhand deformity and Froment's sign. No pre or postoperative complications were reported. With a mean follow-up of 24 months all the metacarpophalangeal joints operated have very good stability and improved strength.
Belmahi
A M
AM
Service de chirurgie plastique et chirurgie de la main, hôpital Avicenne, Rabat, Maroc. belmahi@wanadoo.net.ma
Gharib
N
N
Abbassi
A
A
D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000517:prevention & control*; D008297:Male; D008662:Metacarpophalangeal Joint / Q000002:abnormalities / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D013536:Suture Techniques; D016896:Treatment Outcome; D020424:Ulnar Neuropathies / Q000601:surgery*