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|Patients with tight lateral cords may develop rotational deformities in the digits as with this patient with a pronated ring finger from a radial lateral digital cord:|
|Patients may also have secondary rotational forces which persist after Dupuytren's surgery for severe MCP contractures - the most insidious being unilateral intrinsic tightness and sagittal band attenuation with extensor subluxation. This patient has both, affecting adjacent sides of the middle and ring fingers, resulting in dynamic scissoring after palmar fasciectomy, with no residual palpable Dupuytren's in these digits:|
The tight pull from combined pretendinous/natatory cords can also rotate and overlap digits, and may require web space release.
Longstanding cases develop secondary capsuloligamentous and joint surface changes, and incomplete correction is to be expected even when the secondary pathology is addressed surgically.
It's tempting to consider a derotational osteotomy, but unless combined with a distal fusion, the soft tissue pull will simply rotate the joint enough to offset the effect - that's what happens following a proximal phalanx dorsal closing wedge osteotomy to attempt to correct a PIP flexion contracture from recurrent Dupuytren's - it fails, completely, because the joint simply flexes more to match the attempted gains from osteotomy.
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