Correction of ulnar claw hand deformity with the modified Stiles-Bunnell procedure

Abstract text (incl. references and figure legends)

Case history:

A 44-year-old male who suffered a traumatic section of the ulnar nerve of the left forearm eleven years ago, resulting in an ulnar claw hand.

Clinical findings:

On physical examination, he presented an intrinsic minus attitude of the fourth and fifth fingers, a fifth finger claw with PIP rigidity and an elastic claw in the fourth finger, as well as a positive Tinnel in the forearm.

Investigation/Results:

The patient presented a chronic alteration of the ulnar nerve in the electromyographic study.

Diagnosis:

Ulnar claw hand as a sequel to a traumatic injury to the ulnar nerve.

Therapy and progressions:

It was decided to perform a modified Stiles-Bunnell procedure by arthrolysis of the PIP of the fifth finger, extraction of the FDS of the third finger and subdivision into four tendon grafts that were transposed into the digital canal and fixed to the A1A2 flexor pulleys. An intrinsic plus splint was placed for six weeks. At present, the patient presents a slight claw attitude of the fifth finger with complete and synchronous mobility of the rest of the fingers.

Comments:

The usual clinical manifestation of ulnar nerve injuries is the ulnar claw hand, more evident in the fourth and fifth fingers, but with involvement of the intrinsic musculature of the entire hand. There are various techniques to correct it, being necessary to individualize the technique chosen for each patient, since the pattern of motor involvement can vary. The modified Stiles-Bunnell technique is a dynamic correction of the claw hand by transferring a digital tendon from the FDS of the third finger divided into four hemitendons for the second to fifth fingers, thus allowing active metacapophalangeal flexion that in turn achieves passive interphalangeal extension of those fingers.

References:

Ozkan, T., Ozer, K., Gulgönen, A. (2003). Three tendon transfer methods in reconstruction of ulnar nerve palsy. The Journal of hand surgery, 28(1), 35–43.

Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.)

No.