The importance of middle or long finger realignment in ulnar drift.

Based upon the hypothesis that ulnar drift is the result of a chain reaction starting with a medial shift of the proximal phalanx at the metacarpophalangeal joint and progessing to subluxation of the extensor tendon and finally subluxation of the metacarpophalangeal joint, the author recommends early operative realignment. The extensor tendon is partially divided and a portion passed through the base of the phalanx, the intrinsic tendons are transferred to divided, the junctura tendnium is served, the periosteum is stripped from the neck of the metacarpal, and areas of bony erosions are curetted. In 25 patients with involvement of the middle finger only, alignment was maintained in all over a period of 3 months to 7 years, the average follow-up period being 1.4 years. When deformity was severe and the radical collateral ligament has been disrupted, correction was not always maintained. Early treatment is recommended.