Extensor Carpi Radialis Longus Tendon Transfer to Extensor Carpi Ulnaris: Does It Significantly Improve the Correction of Radial Deviation in the Rheumatoid Wrist?
Abstract
Introduction: Inflammatory arthritis can lead to caput ulnae syndrome with radial deviation of the wrist and metacarpals. Treatment includes salvage arthroplasty of the distal radioulnar joint and relocation of the extensor carpi ulnaris (ECU) tendon. However, the ECU may be too weak to correct the deviation. To strengthen the ECU, Clayton described the transfer of the extensor carpi radialis longus (ECRL) tendon to the ECU. The aim of this work is to compare the correction of the radial deviation of the metacarpals in patients with and without transfer of the ECRL to the ECU. Materials and Methods: Retrospective cohort study. Patients with rheumatoid arthritis and caput ulnae syndrome, treated with ECU tenoplasty with or without ECRL, were included. The patientswere divided into two groups: ECRL to ECU transfer (group A) and no transfer (Group B). The correction of the metacarpal-radial angle (Clayton’s angle) was calculated by comparing the measurements before surgery and at end of follow-up, and the results obtained were compared. Results: The average follow-up was 28 months. The preoperative Clayton angle was on average 44.54° (SD ± 7.52) in group A and 60.24° (SD ± 12.28) in group B (p = 0.001). The correction average was 6.57° (SD ± 4.11) and 0.95° (SD ± 9.17) for group A and B respectively (p=0.026). Conclusions: The level of correction obtained was higher in group A. However, although both techniques managed to improve the angle, the degree of correction could be subject to the magnitude of the preoperative angle.Downloads
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