Surgical treatment of sagittal band injury and classification according to operative findings

Purpose: The indications for surgery in patients with acute closed sagittal band injuries are still undecided. The purpose of this study is to classify the types of injuries based on intraoperative findings of patients who underwent surgery for sagittal injury, and to present treatment plans and surgical methods.Methods: Twenty-five patients who had undergone surgical exploration for closed sagittal band injury between January 2011 and December 2020 were included in the study, comprising of 17 patients with acute injury within 3 weeks, four patients with chronic injury, and four patients who underwent surgery because symptoms did not improve during conservative treatment were included. Patients with laceration, fracture, and rheumatoid arthritis were excluded. Results: Sagittal band injury was classified into two groups: superficial sagittal band (SSB) injury and proper sagittal band (PSB) injury. SSB injury was observed in 75.0% of spontaneous rupture cases and PSB injury was observed in 66.7% of traumatic rupture cases. SSB injury was observed in 83.3% of Rayan and Murray classification type II cases and PSB injury was observed in 61.5% of type III cases (p=0.041). All four patients who failed conservative treatment and underwent surgery had PSB injuries.Conclusion: We successfully corrected the sagittal band injury with extensor digitorum communis tendon instability through surgical treatment. Sagittal band injury can be classified into two types depending on the anatomical injury pattern; SSB and PSB injuries. Surgical method and treatment plan can be chosen based on this.