The Extensor Digiti Quinty (EDQ) Opponensplasty—Revisited

Abstract

Introduction: The extensor digiti quinty (EDQ) opponensplasty, although previously described, is not widely used by hand surgeons. This tendon transfer was used selectively in cases of combined median-ulnar nerve palsies at our center over the last 4 years, with the primary goal to preserve the extensor indices proprius (EIP) for pinch plasty. We present our technique and the series of 8 patients that underwent EDQ opponensplasty here. Materials and Methods: A retrospective chart review identified patients with combined median-ulnar nerve palsies that underwent EDQ opponensplasty between 2015 and 2019 at our institution by a single surgeon. Primary outcome measures collected were pinch, grip, disabilities of the arm, shoulder, and hand (DASH) scores, thumb position, palmar abduction angle, and thumb span. Secondary outcomes included donor site morbidity and complications. Results: Eight patients (9 hands) ages 21 to 53 underwent EDQ opponensplasty, with an average follow-up of 8 months. Postoperative pinch and grip on the affected side improved from preoperative values. All 9 transfers were functional with the thumb positioned in the palmar plane of the hand. Palmar abduction ranged from 45 to 70 degrees. Motor reeducation was achieved without any difficulty in all patients. No patients had evidence of donor site morbidity. Discussion: The EDQ opponensplasty is satisfactory in achieving thumb opposition in the setting of combined median-ulnar neuropathy, without evidence of donor site morbidity. The EDQ is expendable, has adequate length, an optimal line of pull, minimal donor site morbidity, and leaves the extensor indices proprius available for pinch plasty.