Sagittal band reconstruction (Middle finger)
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This is a detailed step by step instruction through a Middle finger Sagittal band reconstruction using a central segment of the extensor apparatus to realign and hold the extensor tendon in place during metacarpo-phalangeal joint (MCPJ) flexion.
It is performed through a dorsal midline approach.
This method is a modification of that published by Charles Carroll in 1987 (see results section).
This is a procedure performed when the sagittal band, usually the radial sided band, ruptures. This is most commonly as a result of inflammatory arthritis but may also be required in neglected traumatic ruptures where a primary repair is not possible.
The procedure can be performed as a day case under regional or general anaesthetic and takes around 1 hour.
Following a period of 1 week in plaster cast the patient then starts mobilisation with active flexion and extension and a volar based splint which limits MCPJ flexion to 30 degrees for 2 weeks, 60 degrees for 2 weeks then 90 degree for the final 2 weeks.
The joint will always appear swollen however the majority of post operative swelling will resolve by 3 months.
Author: Mr Mark Brewster FRCS (Tr & Orth)
Institution: The Royal Orthopaedic Hospital, Birmingham ,UK.