Sagittal Band Injury Treatment Complete Guide Surgical Repair vs Conservative Management

Video Description

Comprehensive guide to sagittal band injury treatment covering conservative and surgical management principles. This educational video is designed for orthopedic surgery residents, medical students, and hand surgery fellows studying extensor tendon injuries at the metacarpophalangeal (MCP) joint.

Key Learning Points:
? Understand when to choose conservative vs surgical treatment based on acuity, chronicity, and patient factors
?
? Master the principles of relative motion extension splinting (Yoke splint) for acute injuries?
? Learn 8 different surgical reconstruction techniques with step-by-step approaches?
? Recognize appropriate indications for each surgical technique?
? Understand rehabilitation protocols and expected outcomes?
? Manage complications including recurrent subluxation and stiffness

Treatment Principles Covered:

Early recognition improves conservative treatment success (44-100% success rate)

Acute injuries (3 weeks) benefit from splinting protocols

Chronic injuries and failed conservative treatment require surgical reconstruction

Professional athletes may benefit from earlier surgical intervention

Rheumatoid arthritis requires special consideration with synovectomy and medical optimization

Surgical Techniques Explained:

Direct Repair with Imbrication - for acute injuries with good tissue quality

Carroll Kilgore Technique - distally-based EDC slip around radial collateral ligament

Watson Technique - tendon slip through deep transverse intermetacarpal ligament

Junctura Tendinum Transfer - utilizing adjacent extensor connections

Dynamic Lumbrical Transfer (Segalman) - muscle-powered dynamic stabilization

Modified Elson Technique - rigid reconstruction with bone tunnel for index finger

Palmaris Longus Graft - free graft reconstruction for tissue deficiency

Guy-Wire Tensioning - suture anchors through bone tunnels for centralization

Clinical Pearls:

Perform surgery under local anesthesia to allow active intraoperative testing

Set tension with MCP at 60-70° flexion to avoid overtensioning

Release contracted ulnar structures when needed for centralization

Avoid over-tensioning (limits flexion) and under-tensioning (recurrent subluxation)

Protect repair with relative motion splinting for 4-6 weeks postoperatively

Expected Outcomes:

Carroll technique: Pain-free with 90°+ MCP flexion, no recurrence

Watson technique: Average 90° MCP flexion, excellent stability

Direct repair in athletes: Return to sport average 5 months

Conservative treatment: 44-100% success rate in acute cases

Ideal for:
Orthopedic surgery residents preparing for hand surgery rotations
Hand surgery fellows studying extensor tendon injuries
Medical students interested in orthopedic surgery
General orthopedic surgeons managing hand trauma

Physical therapists treating hand injuries

About Dr. Ahmed El-Attar:
Orthopedic surgeon dedicated to providing high-quality medical education for Arabic and English-speaking medical professionals. Subscribe for more comprehensive surgical technique videos and orthopedic educational content.

Related Videos:

Extensor Tendon Injury Zones
MCP Joint Anatomy and Biomechanics
Hand Splinting Techniques
Rheumatoid Hand Surgery
ACL Reconstruction Techniques

This video is for educational purposes only and is intended for medical professionals. It does not constitute medical advice. Always consult current medical literature and follow institutional protocols when treating patients.

References:
Based on current literature including studies by Carroll et al., Watson et al., Segalman et al., and comprehensive reviews of sagittal band injury management


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