Treatment of spontaneous tendon raptures of rheumatoid hand or wrist:an analysis of 9 cases

Objective To introduce the clinical experience of treating spontaneous tendon ruptures of rheumatoid hand or wrist.Methods From March 2001 to October 2005,11 sides in 9 eases of spontaneous extensor tendon rupture at the wrist due to rheumatoid arthritis were treated.Surgical procedures included tendon graft using palmaris longus,tendon transfer using extensor indicis proper,or suturing of the ruptured tendon to the neighboring tendon.Three cases with distal radioulnar joint subluxation were treated with Darrach or Sauve- Kapandji procedure.The ulnar stump was stabilized by part of the extensor carpi unlaris tendon.Results Average postoperative follow-up time was 8.5 months.Mild tendon adhesion was observed in 6 fingers which resolved after rehabilitation.Average flexion of metacarpophalangeal joints of the four fingers was 63°.Active extension of the MP joints was-23°,while passive MP joint extension was-10°on average.Extension of interphalangeal joint of the thumb averaged 0°.Active and passive flexion of thumb IP joint was 60°on average. There was no complication such as radioulnar convergence or instability of the proximal unlar stump among the 3 cases treated by the Darrach or Sauve-Kapandji procedure.Conclusion It is necessary to look for signs of tendon rapture when examine patients of Larsen IV or more severe rheumatoid arthritis.Tendon graft or tendon transfer are valid methods to repair the ruptured tendons.The decision of using Darrach or Sauve-Kapandji procedure depends on the age and life style of the patients.