Details of a Researcher - Iwamoto, Takuji

Papers - Iwamoto, Takuji

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手指変形性関節症における示指環指比の検討

石井和典, 岩本卓士, 稲葉尚人, 林健太郎, 寺坂幸倫, 佐藤和毅

日本手外科学会雑誌 ((一社)日本手外科学会) 36 ( 3 ) 344 - 347 2019.12

ISSN 2185-4092

手指関節痛を有し当院外来を受診した女性患者における示指環指比を測定し,統計学的検討をおこなった.本研究では症候性の手指変形性関節症(HOA)群ではControl群と比較してType 3(示指<環指)の割合が多く,両群ともにType 1(示指>環指)の割合が少なかった.HOA群のOAスコアはType 3でType 2(示指=環指)よりも高値であったが有意差は認められなかった.第2/第4中手骨長の比とOAスコアの間には,前期高齢者群では正の相関を認め,後期高齢者群では負の相関を認めた.肢位によっては示指環指比の判別が困難であること,症例数の少なさが本研究における課題であった.(著者抄録)

後方転位した鎖骨近位端骨折に対して骨接合を行った1例

水越諒, 加藤知行, 松村昇, 鈴木拓, 岩本卓士, 佐藤和毅

骨折 ((一社)日本整形外傷学会) 41 ( Suppl. ) S268 - S268 2019.06

ISSN 0287-2285

The relationship between the morphological axis and the kinematic axis of the proximal radius

Oki S., Inaba N., Matsumura N., Iwamoto T., Yamada Y., Jinzaki M., Nagura T.

Surgical and Radiologic Anatomy (Surgical and Radiologic Anatomy) 41 ( 4 ) 423 - 429 2019.04

ISSN 09301038

© 2018, Springer-Verlag France SAS, part of Springer Nature. Purpose: Surgical procedures for impaired forearm rotation such as for chronic radial head dislocation remain controversial. We hypothesized that the morphological axis of the proximal radius is important for stable forearm rotation, and we aimed to clarify the relationship between the morphological axis and the kinematic axis of the proximal radius using four-dimensional computed tomography (4DCT). Methods: Ten healthy volunteers were enrolled. Four-dimensional CT of the dominant forearm during supination and pronation was obtained. The rotation axis of forearm rotation was calculated from all frames during supination and pronation. The principle axis of inertia, which represents the most stable rotation axis of a rigid body, was calculated for the proximal radius by extending its surface data incrementally by 1% from the proximal end. The angle between the kinematic rotation axis and the morphological rotation axis of each length was calculated. Results: The rotation axis of the forearm was positioned on the radial head 0.0 mm radial and 0.4 mm posterior to the center of the radial head proximally and 2.0 mm radial and 1.2 mm volar to the fovea of the ulnar head distally. The principle axis at 15.9% of the length of the proximal radius coincided with the forearm rotation axis (kinematic axis). Individual differences were very small (SD 1.4%). Conclusion: Forearm rotation was based on the axis at 16% of the length of the proximal radius. This portion should be aligned in cases of severe morphological deformity of the radial head that cause “rattling motion” of the radial head after reduction procedures.

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Total finger joint arthroplasty with a costal osteochondral autograft: up to 11 years of follow-up

Sato K., Iwamoto T., Matsumura N., Suzuki T., Nishiwaki Y., Nakamura T.

Journal of Hand Surgery: European Volume (Journal of Hand Surgery: European Volume) 44 ( 2 ) 167 - 174 2019.02

ISSN 17531934

© The Author(s) 2018. The purpose of this study was to evaluate the mid- to long-term clinical outcomes of total finger joint arthroplasty using a costal osteochondral autograft for joint ankylosis. Twenty-three joints (three metacarpophalangeal joints, 20 proximal interphalangeal joints) in 23 patients (19 men and four women) were treated with a costal osteochondral autograft and were evaluated after a mean follow-up of 77 months (60–138). Mean age was 33 years (18 to 55). Significant improvement in active finger extension/flexion was seen from a preoperative mean of −24°/26° (arc: 2°) to −13°/75° (arc: 63°) at latest follow-up. Mean preoperative Japanese Society for Surgery of the Hand version of the Disability of the Arm, Shoulder and Hand score was initially 24 and improved significantly to 5 at latest follow-up. Conclusion: total finger arthroplasty using a costal osteochondral autograft gave an anatomical and biological reconstruction and provided stable improvement at a mean follow-up of 77 months. Level of evidence: IV.

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Normal value and range of the humerus-elbow-wrist angle in a sample of healthy children with even distributions of age, sex, and laterality

Inaba N., Suzuki T., Iwamoto T., Matsumura N., Oki S., Nishiwaki M., Nakamura M., Matsumoto M., Sato K.

Journal of Pediatric Orthopaedics Part B (Journal of Pediatric Orthopaedics Part B) 28 ( 1 ) 57 - 61 2019.01

ISSN 1060152X

© 2018 Wolters Kluwer Health, Inc. All rights reserved. This study was performed to evaluate the normal value of the humerus-elbow-wrist angle (HEWA) in a sample of healthy children with even distributions of age, sex, and laterality. A total of 168 radiographs of the elbows of healthy children with even distributions of age, sex, and laterality were reviewed. The mean HEWA was 12.1° (range: 5°-20°). The value of HEWA was significantly associated with increasing age. Neither sex nor side showed significant differences for the HEWA. The data should be useful for postoperative radiographic assessment of cubitus varus or valgus deformities.

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Computed tomography–based 3-dimensional preoperative planning for unlinked total elbow arthroplasty

Iwamoto T., Suzuki T., Oki S., Matsumura N., Nakamura M., Matsumoto M., Sato K.

Journal of Shoulder and Elbow Surgery (Journal of Shoulder and Elbow Surgery) 27 ( 10 ) 1792 - 1799 2018.10

ISSN 10582746

© 2018 Journal of Shoulder and Elbow Surgery Board of Trustees Hypothesis: Three-dimensional (3D) surgical planning for unlinked total elbow arthroplasty (TEA) would be helpful for estimation of the implant size and accurate placement of implants. Methods: We included 28 patients who underwent TEA with an unlinked total elbow implant in this study. All patients underwent computed tomography scans of the elbow before surgery, and a 3D digital model of the elbow was reconstructed. After the appropriate size and position of the prosthesis were determined, 10 points around the bone tunnel (4 on the humerus and 6 on the ulna) were measured to plan the insertion of the humeral and ulnar stems. Two-dimensional planning was also performed using anteroposterior and lateral radiographs. Intraoperatively, the surgeon measured the planned parameters using a slide gauge to reproduce the 3D planned position of the stem insertion. Results: The stem sizes were accurately estimated in 57% of patients for the humerus and 68% for the ulna with 2-dimensional planning and in 86% for the humerus and 96% for the ulna with 3D planning. The mean differences between the positions of the prostheses after surgery with reference to the planned positions were 0.8° of varus and 1.5° of flexion for the humeral component and 0.7° of varus and 2.9° of flexion for the ulnar component. We did not evaluate rotational positioning in this study. Conclusions: The 3D surgical planning allowed accurate estimation of the implant size and appropriate placement of implants. This method may contribute to a reduced incidence of complications and improved long-term outcomes from TEA.

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Surgical Treatment for Chronic Tendon Mallet Injury

Suzuki T., Iwamoto T., Sato K.

Journal of Hand Surgery (Journal of Hand Surgery) 43 ( 8 ) 780.e1 - 780.e5 2018.08

ISSN 03635023

© 2018 American Society for Surgery of the Hand A variety of surgical options for chronic tendon mallet fingers have been reported. There are advantages and disadvantages to current surgical approaches. We introduce a surgical treatment for chronic tendon mallet injury that involves anatomical reconstruction of the terminal tendon and lateral band with palmaris longus (PL) tendon grafting. Harvested PL tendon is folded in 2 or divided into 2 slips. The graft is attached to a remnant of the original terminal tendon at the distal interphalangeal joint. Both half-slip tendons are passed under the transverse retinacular ligament and sutured side to side to the lateral band at the level of the proximal phalanx. This surgical technique has these advantages: (1) it provides anatomical reconstruction of the terminal tendon; (2) it is indicated regardless of the condition of the terminal tendon and the interval from the initial injury; and (3) it is easy to determine the tension of the grafted tendon. Anatomical reconstruction of the terminal tendon and both lateral bands with PL tendon grafting is useful for chronic tendon mallet injury.

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Costal osteochondral autograft for advanced osteochondritis dissecans of the humeral capitellum in adolescent and young adult athletes clinical outcomes with a mean follow-up of 4.8 years

Sato K., Iwamoto T., Matsumura N., Suzuki T., Nishiwaki Y., Oka Y., Nakamura T.

Journal of Bone and Joint Surgery - American Volume (Journal of Bone and Joint Surgery - American Volume) 100 ( 11 ) 903 - 913 2018

ISSN 00219355

Copyright © 2018 By The Journal Of Bone And Joint Surgery, Incorporated. Background: Costal osteochondral grafting is a technique to achieve anatomical and biological repair of articular defects. Some small series of clinical applications of this procedure for advanced osteochondritis dissecans of the humeral capitellum, with short-term follow-up, have been reported; however, longer-term outcomes remain unclear. The purpose of this study was to clarify longer-term clinical outcomes of costal osteochondral autografts in the treatment of advanced osteochondritis dissecans of the humeral capitellum. Methods: Seventy-two patients with an osteochondral defect of the humeral capitellum were treated with costal osteochondral autograft and followed for a minimum of 3 years (mean follow-up, 57 months; range, 36 to 147 months). The mean patient age was 14.3 years. Clinical outcomes, including elbow range of motion, Timmerman and Andrews clinical rating score, donor-site morbidity, responses to a questionnaire regarding a return to sporting activities, and radiographic findings, were evaluated. Results: The mean elbow range of extension/flexion increased significantly, from 221/122 preoperatively to 24/ 136 postoperatively (p < 0.001). The mean clinical rating score improved significantly, from 101 to 190 by the latest follow-up (p < 0.001). The overall clinical score-based assessment was excellent for 60 patients, good for 9, and fair for 3. Seventy of the 72 patients returned to their original sport. The remaining 2 patients had changed sporting activities before surgery and did not return to baseball, despite satisfactory clinical results. Conclusions: Costal osteochondral autograft successfully achieved anatomical and biological reconstruction in the treatment of advanced osteochondritis dissecans of the humeral capitellum.

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The History and Future of Unlinked Total Elbow Arthroplasty

Iwamoto, T., Ikegami, H., Suzuki, T., Oki, S., Matsumura, N., Nakamura, M., Matsumoto, M. and Sato, K.

Keio J Med (Keio Journal of Medicine) 67 ( 2 ) 19 - 25 2017.08

ISSN 0022-9717

Unlinked total elbow arthroplasty (TEA), which has no mechanical connection between the humeral and ulnar components, has theoretical advantages based on its near-normal elbow kinematics and the preservation of bone stock. Unlinked TEA is appropriate only for patients who have limited bone loss or limited deformity and good ligamentous function. This is because postoperative instability has been a major complication of unlinked prostheses. The concept and goal of unlinked TEA is to share the loading stress on the bone implant interface with the surrounding tissues. Although the loosening rate of unlinked prostheses theoretically should be lower than that of linked prostheses (which have a mechanical connection between the humeral and ulnar components), there is no clear evidence that unlinked TEAs are superior to linked TEAs in this respect. However, we believe that primary TEA should be performed using an unlinked TEA, especially for younger patients, because revision surgery for unlinked TEA results in longer prosthesis survival than revision surgery for linked TEA. Improvement of the design of unlinked prostheses and the introduction of less invasive surgical techniques are required to reduce postoperative instability.

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Migration of a Kirschner wire into the lung with shoulder dislocation

Suzuki, T., Matsumura, N., Iwamoto, T. and Sato, K.

BMJ Case Rep 2017 2017.08

ISSN 1757-790

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Three-dimensional Deformities of Non-operative Midshaft Clavicle Fractures: A Surface Matching Analysis

Oki, S., Matsumura, N., Kiriyama, Y., Iwamoto, T., Sato, K. and Nagura, T.

J Orthop Trauma 31 ( 11 ) E385 - E389 2017.06

ISSN 0890-5339

OBJECTIVE: The purpose of this study was to describe the three-dimensional deformities of midshaft clavicle fractures, which had been treated nonoperatively, using computed tomography (CT) surface matching. METHODS: Twenty-one patients with unilateral midshaft clavicle fracture, who had been treated nonoperatively, were enrolled and evaluated retrospectively. The three-dimensional deformity of the fractured clavicle was evaluated by CT surface matching. CT scans of 21 age- and sex-matched patients with initial traumatic shoulder dislocation or proximal humeral fracture were enrolled as a control group, and the differences in three-dimensional deformities and lengths of the clavicles between the fracture group and the control group were evaluated. A correlation analysis was also performed between rotational deformities and clavicular length shortening. RESULTS: The affected clavicle showed 1.3 +/- 6.9 degrees of downward angular deformity, 2.1 +/- 8.0 degrees of anterior angular deformity, and 5.0 +/- 4.9 degrees of anterior rotational deformity. Compared with the control group, the fractured clavicle showed larger anterior rotational deformity (P = 0.021). Shortening of the clavicle demonstrated negative correlation with anterior axial rotation (R = -0.534, P = 0.013), but no correlation was found between clavicular shortening and the other two rotational deformities. CONCLUSION: In cases of midshaft clavicle fracture, the distal fragment usually rotates anteriorly due to its anatomical relationships. Shortening deformity following clavicle fracture was reported to change shoulder kinematics, and anterior rotational deformity might adversely affect scapular motion.

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Lateral Para-Olecranon Approach for the Treatment of Distal Humeral Fracture

Iwamoto, T., Suzuki, T., Matsumura, N., Nakamura, M., Matsumoto, M. and Sato, K.

J Hand Surg Am 42 ( 5 ) 344 - 350 2017.05

ISSN 0363-5023

PURPOSE: To assess the outcomes of the lateral para-olecranon triceps-splitting approach for the treatment of distal humeral fracture. METHODS: Ten patients (3 males, 7 females) with a mean age of 59 years were retrospectively reviewed. There were 2 A2, 3 C1, and 5 C2 fractures according to the AO/ASIF classification. Types B3 and C3 fractures were excluded from this study because the olecranon osteotomy approach was indicated to visualize the anterior fragment. The triceps was split at the midline, and the anconeus muscle was incised from the proximal ulna. The lateral half of the triceps along with anconeus was retracted laterally as a single unit. The distal part of the humerus could be visualized from medial and lateral windows by retracting the medial half of the triceps. The articular fragment was anatomically reduced and fixed temporarily with a Kirschner wire, and the reconstructed distal articular block was then fixed to the humeral shaft with double locking plates. RESULTS: After surgery, average elbow flexion was 127 degrees (range, 110 degrees -145 degrees ), and extension was -10 degrees (range, -20 degrees -0 degrees ) at the average follow-up time of 12.4 months (range, 820 months). Seven patients had normal muscle strength against full resistance (manual muscle testing grade 5), and the other 3 patients had slightly reduced muscle strength (grade 4). No articular stepoffs of more than 1 mm were seen on postoperative radiographs. There were no cases of triceps insufficiency and nonunion. The average (+/- SD) Mayo Elbow Score was 93.5 +/- 5.8 points at the final follow-up. CONCLUSIONS: The lateral para-olecranon approach is useful for the management of selected fractures of the distal humerus, preserving extension strength and providing satisfactory clinical outcomes, with no risk of olecranon osteotomy-related complications. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic V.

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Predictors of postoperative outcomes of cubital tunnel syndrome treatments using multiple logistic regression analysis

Suzuki, T., Iwamoto, T., Shizu, K., Suzuki, K., Yamada, H. and Sato, K.

J Orthop Sci 22 ( 3 ) 453 - 456 2017.05

ISSN 0949-2658

BACKGROUND: This retrospective study was designed to investigate prognostic factors for postoperative outcomes for cubital tunnel syndrome (CubTS) using multiple logistic regression analysis with a large number of patients. METHODS: Eighty-three patients with CubTS who underwent surgeries were enrolled. The following potential prognostic factors for disease severity were selected according to previous reports: sex, age, type of surgery, disease duration, body mass index, cervical lesion, presence of diabetes mellitus, Workers' Compensation status, preoperative severity, and preoperative electrodiagnostic testing. Postoperative severity of disease was assessed 2 years after surgery by Messina's criteria which is an outcome measure specifically for CubTS. Bivariate analysis was performed to select candidate prognostic factors for multiple linear regression analyses. Multiple logistic regression analysis was conducted to identify the association between postoperative severity and selected prognostic factors. RESULTS: Both bivariate and multiple linear regression analysis revealed only preoperative severity as an independent risk factor for poor prognosis, while other factors did not show any significant association. CONCLUSIONS: Although conflicting results exist regarding prognosis of CubTS, this study supports evidence from previous studies and concludes early surgical intervention portends the most favorable prognosis.

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Medium- to long-term outcomes of anatomical reconstruction of the radioulnar ligament to the ulnar fovea

Nakamura, T., Abe, K., Nishiwaki, M., Iwamoto, T. and Sato, K.

J Hand Surg Eur Vol 42 ( 4 ) 352 - 356 2017.05

ISSN 0266-7681

We examined the medium- to long-term outcome of the original reconstruction technique of the radioulnar ligament using a half-slip of the extensor carpi ulnaris tendon for chronic foveal avulsion of the triangular fibrocartilage complex. We treated 37 wrists in 36 patients with a minimum follow-up of 5 years. Of 36 patients, 12 had more than 10 years follow-up. At final follow-up, 30 patients (31 wrists) reported no pain, five patients (five wrists) reported mild occasional pain and one patient reported severe persistent pain. Two patients had lost 30 degrees of supination. Complete stability of the distal radio-ulnar joint was achieved in 31 wrists, moderate instability was noted in five and severe distal radio-ulnar joint instability remained in one. The size of the bone tunnel was assessed radiologically: in two it had enlarged; in 23 it was unchanged; and in 12 it appeared to have closed over the tendon graft. The overall clinical outcomes were 28 excellent, four good, four fair and one poor. The 12 wrists with more than 10 years follow-up had seven excellent, three good and two fair clinical results. This reattachment technique appears to work and last over the medium- to long-term. LEVEL OF EVIDENCE: IV.

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Chronic calcific periarthritis of the elbow treated by cimetidine administration: Five cases

Kimura, H., Iwamoto, T., Oki, S., Matsumura, N., Nakamura, M., Matsumoto, M. and Sato, K.

J Orthop Surg (Hong Kong) 25 ( 2 ) 2309499017717193 2017.05

ISSN 1022-5536

Calcific periarthritis or calcific tendinitis occurs most frequently in the shoulder and rarely in the elbow. Cimetidine was previously reported to be effective for chronic calcific periarthritis of the shoulder. Here, we present five patients with chronic calcific periarthritis of the elbow treated by administration of cimetidine; there were six affected elbows in these five patients. Although all patients had been treated with nonsteroidal anti-inflammatory drugs for at least 3 months, their symptoms were not relieved. All patients took oral administration of cimetidine 400 mg daily. The pain was completely relieved in an average of 1.8 months after the administration of cimetidine, and the calcification of the elbow disappeared in an average of 5.1 months. During the follow-up period, there were no symptoms suggesting a recurrence. Although the detailed mechanism of action of cimetidine on periarticular calcifications remains to be understood, cimetidine appears to be a potential therapeutic agent for chronic calcific periarthritis.

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Cigarette Smoking Is Associated With Cubital Tunnel Syndrome

Suzuki, T., Iwamoto, T., Ochi, K., Mito, K., Nakamura, T., Suzuki, K., Yamada, H. and Sato, K.

Muscle Nerve 54 ( 6 ) 1136 - 1138 2016.12

ISSN 0148-639

INTRODUCTION: The aim of this study was to validate the potential association between cigarette smoking and cubital tunnel syndrome (CubTS). METHODS: One hundred patients with CubTS were compared with 100 controls with ulnar abutment syndrome matched for age, gender, and body mass index. The smoking status was compared between patients and controls using the sign test and the Wilcoxon signed rank test. Conditional logistic regression was used to calculate the association between CubTS and pack-years smoked. RESULTS: A significant association was found between increased pack-years smoked and CubTS. A significant difference in the number of never smokers and ever smokers was observed between the patients with CubTS and controls. The difference in mean pack-years in the patients and controls was highly significant. A dose-dependent association with pack-years was found between patients and controls. CONCLUSIONS: High cumulative cigarette smoking is associated with CubTS. Muscle Nerve 54: 1136-1138, 2016.

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Subcutaneous flexor tendon rupture in patients with rheumatoid arthritis

Funahashi, T., Suzuki, T., Iwamoto, T., Shizu, K., Matsumura, N., Ochi, K., Ikari, K., Sato, K., Nakamura, M., Matsumoto, M., Momohara, S., Suzuki, K. and Yamada, H.

Mod Rheumatol 26 ( 6 ) 869 - 872 2016.11

ISSN 1439-7595

OBJECTIVE: We examined the clinical features and functional outcomes of surgically repaired subcutaneous flexor tendon ruptures in patients with rheumatoid arthritis (RA). METHODS: This retrospective study included 41 fingers of 24 RA patients who underwent surgical treatment for flexor tendon ruptures. Evaluations performed at the time of presentation following rupture were C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and disease activity score in 28 joints (DAS28)-ESR, as well as Larsen grading for carpal bone destruction. The ruptured tendon and postoperative active range of motion (ROM) of digits were also examined. RESULTS: The mean CRP was 2.4 mg/dl, ESR was 52 mm/h, and the DAS28-ESR was 4.5. Carpal bone destruction according to Larsen grade IV-V was observed in 18/24 patients. Affected digits were most commonly the thumb (12) and the ring and little fingers (9 each). Tendon ruptures were most common in the carpal tunnel in zone IV. The mean postoperative finger ROM (flexion/extension) was 38 degrees /2 degrees for the interphalangeal (IP) joint of the thumb and 23 degrees /-2 degrees for the distal interphalangeal joint of the other four fingers. CONCLUSIONS: Patients with flexor tendon ruptures present with high disease activity and advanced bone destruction. It is important to reduce the risk of progressive bone destruction and subsequent tendon rupture via tight control of disease activity.

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Radial deviation of the finger caused by an occult intramuscular ganglion in a patient with rheumatoid arthritis

Kato, T., Iwamoto, T., Matsumura, N., Sato, K., Nakamura, T. and Toyama, Y.

Mod Rheumatol 26 ( 4 ) 607 - 9 2016.07

ISSN 1439-7595

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Partial obturator nerve transfer for femoral nerve injury: A case report

Inaba, N., Sato, K., Suzuki, T., Iwamoto, T., Ochi, K., Nakamura, M., Matsumoto, M. and Toyama, Y.

J Orthop Sci (Journal of Orthopaedic Science) 23 ( 1 ) 202 - 204 2016.06

ISSN 0949-2658

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Modified Extensor Pollicis Longus Rerouting Technique for Boutonniere Deformity of the Thumb in Rheumatoid Arthritis

Iwamoto, T., Sakuma, Y., Momohara, S., Matsumura, N., Ochi, K. and Sato, K.

J Hand Surg Am 41 ( 6 ) e129 - 34 2016.06

ISSN 0363-5023

PURPOSE: To assess the outcomes of a modified extensor pollicis longus (EPL) rerouting technique for boutonniere deformity of the thumb in patients with rheumatoid arthritis. METHODS: A total of 21 thumbs in 18 patients with a mean age of 63 years were retrospectively analyzed after an average follow-up period of 3.2 years. The preoperative deformities were classified as either mild (5 thumbs) or moderate (16 thumbs). After either metacarpophalangeal (MCP) joint synovectomy or implant arthroplasty, the ulnarly dislocated EPL tendon was reduced dorsally and sutured to the dorsal base of the proximal phalanx. If the interphalangeal (IP) joint extended with manual traction on the proximal portion of the extensor pollicis brevis tendon, no further treatment was considered. If the IP joint did not extend with this maneuver, the insertion of the extensor pollicis brevis tendon was dissected and transferred to the distal portion of the EPL tendon. RESULTS: The average MCP joint extensor lag improved from 62 degrees (range, 32 degrees to 85 degrees ) before surgery to 17 degrees (range, active extension 12 degrees to extensor lag 70 degrees ) at the final follow-up (P < .05), whereas average MCP joint flexion decreased from 83 degrees (range, 52 degrees to 95 degrees ) to 68 degrees (range, 30 degrees to 90 degrees ) (P < .05). Hyperextension at the IP joint was improved from 30 degrees (range, 10 degrees to 50 degrees ) before surgery to an average extensor lag of 2 degrees (range, extensor lag 24 degrees to hyperextension 20 degrees ) at the final follow-up. The average combined MCP and IP motion did not significantly change. The boutonniere deformity was improved in 18 of 21 thumbs. The 3 failures all had moderate-stage deformity prior to treatment. CONCLUSIONS: A modified EPL rerouting technique provided satisfactory results together with a low risk of IP joint extension loss. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

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