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Observation alone
1%
62/5646
Continued splinting in flexion
61/5646
Continued splinting in extension
16%
881/5646
Open repair of the disrupted junctura tendinae
6%
339/5646
Open repair of the disrupted sagittal band
76%
4279/5646
Select Answer to see Preferred Response
Based on the history and physical exam findings this patient has sustained a traumatic rupture of the sagittal band. In this professional athlete, the next best step would be to perform an open repair of the sagittal band. This will allow for earlier aggressive rehabilitation and a quicker return to sport. Sagittal band ruptures may be traumatic (as in this case) or attritional in nature (as in rheumatoid arthritis). A direct blow to the MCP leads to forced flexion of the digit and subsequent stretching/rupture of the affected structure. On physical exam the tendons are most unstable with the wrist flexed; MCP flexion will lead to dislocation of the tendon into the intermetacarpal gutter. Acute injuries may be treated with extension bracing for 4-6 weeks, but in professional athletes, direct open repair of the sagittal band is indicated. Catalano et al. review sagittal band injuries treated with a thermally molded plastic splint that held the MCP in ~25-35 degrees of hyperextension. Patients were evaluated over 14 months; out of 11 sagittal band injuries, splinting was successful in eight of them. They recommend initial nonsurgical management with custom splinting. Hame et al. review the results of the management of sagittal band injuries in the professional athlete. The lesion commonly found was the disruption of the extensor mechanism with predictable sagittal band tears. In their series, all patients regained full range of motion and returned to their respective sports. They recommend surgical intervention in elite athletes in the form of extensor tendon centralization and sagittal band repair. Figure A shows a T1 weighted axial cut of the affected hand; subluxation of the tendon (arrow) can be identified with disruption of the sagittal band (arrowhead). The video provided briefly reviews injury to the sagittal band. Incorrect Answers Answer 1: Observation is not indicated in this patient Answer 2, 3: Splinting in extension would be an acceptable option in the non-athlete, but direct repair is indicated in a professional athlete Answer 4: The junctura tendinae are not injured in this patient
2.6
(25)
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