Relationship of surgically repaired ulnar collateral ligament injury of the thumb to the morphology of the metacarpophalangeal joint of the thumb
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Metacarpophalangeal joint
The non-operative method of reduction of locking metacarpophalangeal joint of the thumb is described, and illustrated by four case reports. Experimental studies in the hands of a fresh cadaver are also described. Locking of the metacarpophalangeal joint of the thumb can be produced by slight external forces, insufficient to damage strong tissues. Incarceration of the sesamoid bone is anatomically impossible, but incarceration of the proximal portion of the volar plate is believed to be the true cause. This incarceration can be reduced easily by our non-operative method along with intra-articular injection of local anaesthetics.
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A stable metacarpophalangeal joint of the thumb is indispensable for a normal grip function of the hand. The joint is stabilized by collateral ligaments. A rupture of the ulnar, collateral ligament is often caused by a sports trauma, as indicated by the denominations "skiërs duim", "goalkeeper's thumb" and "baseball thumb". Many surgeons are not familiar with the phenomenon of an insufficient collateral ligament, also called "wackeldaum". In the period 1981-1985 a consecutive series of 35 patients with a ruptured ulnar collateral ligament was operated in the De Wever hospital Heerlen (Netherlands). On the basis of our own patients, attention is given to the diagnosis, therapy and results of the operative treatment of these lesions.
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Introduction: Ulnar collateral ligament (UCL) of the thumb injury is a very common injury. However, due to the complexity of the ligament anatomy, the inexperience of doctors and unavailability of diagnostic procedures, the ulnar collateral ligament of the thumb injury is most commonly overseen. The consequences are loss of thumb function, instability and pain in the metacarpophalangeal joint, and accelerated osteoarthrosis. For these precise reasons, there is a clear consensus that this injury should be treated operatively. Objective: The objective of this paper is to present the results of the pull-out technique for reconstructing the UCL ligament. Methodology: In between 2018 and 2020, we have operated on 11 patients with the UCL of the thumb rupture in our department. We approached the dorsoulnar side of the metacarpophalangeal (MCP) joint of the thumb using the standard lazy S incision. In 9 out of 11 patients, a Stener ligament lesion was discovered. All patients had their ligament reconstructed using the pull-out technique, where the ligament was sewn through, then guided through a channel created using a K needle on the radial side of the base of the thumb. Postoperatively, a spica plaster orthosis was placed on the thumb. Results: The patients returned for re-evaluation 6, 12 and 24 weeks after surgery. Upon 24 weeks, the patients had no complaints regarding their thumb, they had full grip strength and could perform all the various grips. Two of the patients had a limited abduction amplitude of the thumb in the MCP joint, which didn't affect the outcome. There was no injury to the sensory branch of the radial nerve. Conclusion: The pull-out technique is a safe, quick and cheap operative technique for UCL of the thumb reconstruction.
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Double fracture-dislocations of the thumb are rare. Only a single case report of a simultaneous extraarticular fracture of the base of the first metacarpal and dislocation of the metacarpophalangeal joint has been previously reported. We report the second case report of this injury in a 20-year-old man. The patient had an excellent outcome after treatment.
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A method of reconstruction of the long standing rupture of ulnar collateral ligament of the thumb is described. Its advantage is the tightness with which the tendon used for repair can be sutured to achieve maximum stability. This has been used in eight patients in the past four years and provided a stable and painless thumb.
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Fracture of thumb sesamoids is a rare injury. We are reporting four cases. In two cases, the fracture involved the ulnar sesamoid and in two others, the radial sesamoid. The right thumb was affected in two patients and the left thumb in the other two. In one patient, arthrography of the metacarpophalangeal joint of the thumb demonstrated contrast leakage from the volar aspect of the joint and confirmed volar plate rupture. All patients were treated conservatively with immobilization. Normal hand function was restored in all four patients. Sesamoid fractures may accompany severe injuries of the fibrous plate. Radiologists and orthopaedists should be aware of the possibility of this fracture in injuries of the thumb. Early recognition of the fracture leads to appropriate treatment and avoids possible instability of the metacarpophalangeal joint.
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