Metacarpophalangeal joint stiffness. Still a challenge for the hand surgeon?
OBJECTIVE
The aim of this study is to analyse the outcomes of the surgical treatment of metacarpophalangeal stiffness by dorsal teno-arthrolysis in our centre, and present a review the literature.


METHODS
This is a retrospective study of 21 cases of metacarpophalangeal stiffness treated surgically. Dorsal teno-arthrolysis was carried out on all patients. A rehabilitation programme was started ten days after surgery. An evaluation was performed on the aetiology, variation in pre- and post-operative active mobility, complications, DASH questionnaire, and a subjective satisfaction questionnaire.


RESULTS
The mean age of the patients was 36.5 years and the mean follow-up was 6.5 years. Of the 21 cases, the most common cause was a metacarpal fracture (52.4%), followed by complex trauma of the forearm (19%). Improvement in active mobility was 30.5°, despite obtaining an intra-operative mobility 0-90° in 80% of cases. Mean DASH questionnaire score was 36.9 points. The outcome was described as excellent in 10% of our patients, good in 30%, poor in 40%, and bad in the remaining 20%. There was a complex regional pain syndrome in 9.5% of cases, and intrinsic muscle injury in 14.3%.


CONCLUSIONS
Because of its difficult management and poor outcomes, surgical treatment of metacarpophalangeal stiffness in extension is highly complex, with dorsal teno-arthrolysis being a reproducible technique according to our results, and the results reported in the literature.
Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, España. Electronic address: isidro_jimenez@hotmail.com.
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Jiménez
Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, España.
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Muratore-Moreno
Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, España.
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Marcos-García
Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, España.
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Medina
D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007592:Joint Diseases / Q000534:rehabilitation / Q000601:surgery*; D008297:Male; D008662:Metacarpophalangeal Joint / Q000601:surgery*; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods* / Q000534:rehabilitation; D012189:Retrospective Studies; D016896:Treatment Outcome
Articular; Extension; Extensión; Joint; Metacarpofalángica; Metacarpophalangeal; Rigidez; Stiffness; Tratamiento; Treatment