Enhanced Outcomes With Modern Fixation Devices In Mcp Capsulodesis For Claw Hand Deformity

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PURPOSE: Claw hand deformity is marked by metacarpophalangeal (MCP) joint hyperextension and proximal interphalangeal (PIP) joint flexion. It results from intrinsic muscle paralysis and severely compromises hand function. Traditional volar plate capsulodesis (VPC) has been demonstrated to have a 50% failure rate and is limited by recurrent deformity due to volar plate attenuation. This study evaluates a modified VPC technique using an internal brace to reinforce the volar plate and prevent recurrent hyperextension. METHODS: A retrospective review of 19 individual finger capsulodesis procedures from nine patients (mean age 54.5 ± 18.9 years; 50.0% male) who underwent MCP capsulodesis between 2022-2025 for claw hand deformity with positive Bouvier test results. The primary outcome was maintenance of MCP joint flexion without recurrence of hyperextension deformity. Mean follow-up was 13.4 months (range 7.4 months - 24.1 months). Device type, finger distribution, and digit-specific success rates were analyzed. RESULTS: Overall success was achieved in 94.7% (18/19) of procedures. Success rates were: thumb 100% (n=1/1), index finger 75% (n=3/4), middle finger 100% (n=4/4), ring finger 100% (n=5/5), and small finger 100% (n=5/5). Device-specific outcomes favored modern fixation systems including SwiveLock anchors 100% (n=7/7), bone screws 100% (n=2/2), Anchor suture 3-0 nano cork screw 100% (n=4/4), and Arthrex internal brace devices 83.3% (n=5/6). CONCLUSION: The internal brace modification of MCP capsulodesis provides superior structural support and improved durability compared to traditional VPC. Modern fixation systems, particularly SwiveLock anchors and bone screws, yielded the most reliable outcomes. This technique represents a significant advancement in claw hand correction, offering durable functional improvement for patients with intrinsic hand paralysis. *Source: https://ps-rc.org/meeting/Program/2026/AS24.cgi*

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