Crossed intrinsic transfer for the treatment of ulnar drift in rheumatoid hand

ABSTRACT

This work was conducted at the University of Iowa Hospitals and clinics, USA. The study retrospectively evaluated 19 rheumatoid patients in whom crossed intrinsic transfer [CIT] had been performed. The patients were 14 women and 5 men with an average duration of preoperative disease of 10.6 years. The average age at operation was 52.5 years. Patients were followed in the outpatient clinics at regular intervals. The overall duration of follow-up averaged 5.8 years.CIT resulted in correction of ulnar drift from an average of 30 degrees preoperatively to 14 degrees postoperatively. Only 2% had recurrent ulnar drift of more than 20 degrees at the final follow-up. The addition of Extensor Carpi Radicals Longues to Exensor Carpi Ulnars [ECRL to ECU] transfer did not affect the effectiveness of CIT in correcting ulnar drift. The overall motion loss was significant only at the MP joint and averaged 18 degrees for the whole duration of follow-up. Analysis of motion data at different follow-up durations showed that significant deterioration in the active ROM of all joints started to occur at 5-10 years. It can he concluded that CIT results in significant long term correction of ulnar drift. Deterioration in the MP motion does occur but the MP are of motion remains within the functional range. This procedure should be done before joint dislocation or fixed contractures occur. Although not intended to replace arthroplasty where the articular surface is destroyed, early CIT prevents progressive deformity at the MP joint and may preclude the need for arthroplasty