The fixed lupus hand deformity and its surgical correction.

In a prospective study of 125 patients with SLE, three females developed fixed hand deformities. All had arthritis for more than 10 years, and had been treated with a mean daily dose of 15 mg of prednisone. The hand deformities consisted of irreducible metacarpophalangeal (MCP) subluxation and/or dislocation without erosion or destruction of the MCP joints, resulting in hyperflexion of the fingers in the palm. Two patients had dislocation of the carpometacarpal joints in both hands. On patient developed reducible swan-neck deformities in the second to fifth fingers of both hands and a second patient developed Boutonniere deformities in two fingers of one hand and clinodactyly of both fifth fingers. Because the deformity at the MCP joints resulted from soft tissue contractures in the intrinsics and long flexors, and because the cartilage of the MCP joint was preserved, a joint replacement was not considered. Metacarpal osteotomy and shortening was performed to decompress the contracted soft tissues. At follow-up (18-96 months), the hands remained corrected and all patients were able to perform normal activities.