Extensor indicis opponensplasty: a modified evaluation system

Abstract

Background

Extensor indicis opponensplasty is the gold standard treatment for the restoration of opposition in individuals with median nerve injuries, and it has excellent outcomes. Most authors have used the Sundraraj and Mani scoring system, which considered a thumb reaching any fingertip as a good or excellent outcome. To refine the technique for extensor indicis opponensplasty, we propose an informative yet simple system to describe outcomes.

Methods

This study included 13 patients who underwent extensor indicis opponensplasty for median nerve injuries, with four isolated and nine combined. Six patients had triple insertions, and seven had single/double insertions. The patients were evaluated using the Sundraraj and Mani system and our proposed system for the primary outcome. Secondary outcomes included return to productivity and complications.

Results

We demonstrated that 92% of the patients achieved excellent results according to the Sundraraj and Mani system. We achieved pulp to little pulp (5A) in seven patients, tip to little pulp (5B) in two patients, pulp to ring pulp (4A) in one patient, tip to ring pulp (4B) in one patient, pulp to middle finger pulp (3A) in one patient, and fair opposition (1) in one patient. A 5A score was achieved in five patients with triple insertion.

Conclusions

The new system proposed in this study better facilitates the comparison of technical variations of opponensplasty.

Level of evidence:Level IV, therapeutic study.

http://bit.ly/2MSZ9iE