TREATMENT OF ULNAR COLLATERAL LIGAMENT AVULSION FRACTURE OF THUMB METACARP-OPHALANGEAL JOINT USING A COMBINATION OF Kirschner WIRE AND SILK TENSION BAND_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

GAO Shunhong

No.2 Department of Hand Surgery, the Second Hospital of Tangshan, Affiliated Orthopedic Hospital of Hebei United University, Tangshan Hebei, 063000, P.R.China. Corresponding author: GAO Shunhong, E-mail: gshdj@126.com;

Corresponding author：

Keywords：

Ulnar collateral ligament avulsion fracture; Thumb metacarpophalangeal joint; Kirschner wire; Silk tension band

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Objective To investigate the effectiveness of Kirschner wire combined with silk tension band in the treatment of ulnar collateral ligament avulsion fracture of the thumb metacarpophalangeal joint. Methods Between September 2008 and October 2011, 14 patients with ulnar collateral ligament avulsion fracture of the thumb metacarpophalangeal joint were treated using a combination of Kirschner wire and silk tension band. There were 8 males and 6 females, aged 23-55 years (mean, 40.8 years). The causes of injury were machinery twist injury in 5 cases, manual twist injury in 4 cases, falling in 4 cases, sports injury in 1 case. The time from injury to operation was 2 hours-14 days. All the patients presented pain over the ulnar aspect of the metacarpophalangeal joint of the thumb, limitation of motion, and joint instability with pinch and grip. The lateral stress testing of the metacarpophalangeal joint was positive. Function training was given at 2 weeks after operation. Results All incisions healed by first intention. The lateral stress testing of the metacarpophalangeal joint was negative. All the patients were followed up 6-18 months (mean, 13.1 months). The X-ray films showed good fracture reduction and healing with an average time of 7 weeks (range, 4-10 weeks). At last follow-up, the thumbs had stable flexion and extension of the metacarpophalangeal joint, normal opposition function and grip and pinch strengths. According to Saetta et al. criteria for functional assessment, the results were excellent in 11 cases and good in 3 cases; the excellent and good rate was 100%. Conclusion It is an easy and simple method to treat ulnar collateral ligament avulsion fracture of the thumb metacarpophalangeal joint using Kirschner wire combined with silk tension band, which can meet the good finger function.

Citation： GAO Shunhong,FENG Shiming,JIAO Cheng.. TREATMENT OF ULNAR COLLATERAL LIGAMENT AVULSION FRACTURE OF THUMB METACARP-OPHALANGEAL JOINT USING A COMBINATION OF Kirschner WIRE AND SILK TENSION BAND. Chinese Journal of Reparative and Reconstructive Surgery, 2012, 26(12): 1466-1468. doi: Copy

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2.	Tang P. Collateral ligament injuries of the thumb metacarpophalangeal joint. J Am Acad Orthop Surg, 2011, 19(5): 287-296.
3.	Papandrea RF, Fowler T. Injury at the thumb UCL: is there a Stener lesion? J Hand Surg (Am), 2008, 33(10): 1882-1884.
4.	Chuter GS, Muwanga CL, Irwin LR. Ulnar collateral ligament injuries of the thumb: 10 years of surgical experience. Injury, 2009, 40(6): 652-656.
5.	Ritting AW, Baldwin PC, Rodner CM. Ulnar collateral ligament injury of the thumb metacarpophalangeal joint. Clin J Sport Med, 2010, 20(2): 106-112.
6.	Anderson D. Skier’s thumb. Aust Fam Physician, 2010, 39(8): 575-577.
7.	Frank WE, Dobyns J. Surgical pathology of collateral ligamentous injuries of the thumb. Clin Orthop Relat Res, 1972, (83): 102-114.
8.	Camp RA, Weatherwax RJ, Miller EB. Chronic posttraumatic radial instability of the thumb metacarpophalangeal joint. J Hand Surg (Am), 1980, 5(3): 221-225.
9.	Saetta JP, Phair IC, Quinton DN. Ulnar collateral ligament repair of the metacarpo-phalangeal joint of the thumb: a study comparing two methods of repair. J Hand Surg (Br), 1992, 17(2): 160-163.
10.	Smith RJ. Post-traumatic instability of the metacarpophalangeal joint of the thumb. J Bone Joint Surg (Am), 1977, 59(1): 14-21.
11.	Dinowitz M, Trumble T, Hanel D, et al. Failure of cast immobilization for thumb ulnar collateral ligament avulsion fractures. J Hand Surg (Am), 1997, 22(6): 1057-1063.
12.	Kozin SH, Bishop AT. Tension wire fixation of avulsion fractures at the thumb metacarpophalangeal joint. J Hand Surg (Am), 1994, 19(6): 1027-1031.
13.	Baskies MA, Lee SK. Evaluation and treatment of injuries of the ulnar collateral ligament of the thumb metacarpophalangeal joint. Bull NYU Hosp Jt Dis, 2009, 67(1): 68-74.
14.	Rettig A, Rettig L, Welsch M. Anatomic reconstruction of thumb metacarpophalangeal joint ulnar collateral ligament using an interference screw docking technique. Tech Hand Up Extrem Surg, 2009, 13(1): 7-10.
15.	Katolik LI, Friedrich J, Trumble TE. Repair of acute ulnar collateral ligament injuries of the thumb metacarpophalangeal joint: a retrospective comparison of pull-out sutures and bone anchor techniques. Plast Reconstr Surg, 2008, 122(5): 1451-1456.
16.	Watanabe K. A simple method of osteosynthesis for avulsion fractures of the thumb metacarpophalangeal joint. Hand Surg, 2005, 10(2-3): 209-211.

1. Patel S, Potty A, Taylor EJ, et al. Collateral ligament injuries of the metacarpophalangeal joint of the thumb: a treatment algorithm. Strategies Trauma Limb Reconstr, 2010, 5(1): 1-10.
2. Tang P. Collateral ligament injuries of the thumb metacarpophalangeal joint. J Am Acad Orthop Surg, 2011, 19(5): 287-296.
3. Papandrea RF, Fowler T. Injury at the thumb UCL: is there a Stener lesion? J Hand Surg (Am), 2008, 33(10): 1882-1884.
4. Chuter GS, Muwanga CL, Irwin LR. Ulnar collateral ligament injuries of the thumb: 10 years of surgical experience. Injury, 2009, 40(6): 652-656.
5. Ritting AW, Baldwin PC, Rodner CM. Ulnar collateral ligament injury of the thumb metacarpophalangeal joint. Clin J Sport Med, 2010, 20(2): 106-112.
6. Anderson D. Skier’s thumb. Aust Fam Physician, 2010, 39(8): 575-577.
7. Frank WE, Dobyns J. Surgical pathology of collateral ligamentous injuries of the thumb. Clin Orthop Relat Res, 1972, (83): 102-114.
8. Camp RA, Weatherwax RJ, Miller EB. Chronic posttraumatic radial instability of the thumb metacarpophalangeal joint. J Hand Surg (Am), 1980, 5(3): 221-225.
9. Saetta JP, Phair IC, Quinton DN. Ulnar collateral ligament repair of the metacarpo-phalangeal joint of the thumb: a study comparing two methods of repair. J Hand Surg (Br), 1992, 17(2): 160-163.
10. Smith RJ. Post-traumatic instability of the metacarpophalangeal joint of the thumb. J Bone Joint Surg (Am), 1977, 59(1): 14-21.
11. Dinowitz M, Trumble T, Hanel D, et al. Failure of cast immobilization for thumb ulnar collateral ligament avulsion fractures. J Hand Surg (Am), 1997, 22(6): 1057-1063.
12. Kozin SH, Bishop AT. Tension wire fixation of avulsion fractures at the thumb metacarpophalangeal joint. J Hand Surg (Am), 1994, 19(6): 1027-1031.
13. Baskies MA, Lee SK. Evaluation and treatment of injuries of the ulnar collateral ligament of the thumb metacarpophalangeal joint. Bull NYU Hosp Jt Dis, 2009, 67(1): 68-74.
14. Rettig A, Rettig L, Welsch M. Anatomic reconstruction of thumb metacarpophalangeal joint ulnar collateral ligament using an interference screw docking technique. Tech Hand Up Extrem Surg, 2009, 13(1): 7-10.
15. Katolik LI, Friedrich J, Trumble TE. Repair of acute ulnar collateral ligament injuries of the thumb metacarpophalangeal joint: a retrospective comparison of pull-out sutures and bone anchor techniques. Plast Reconstr Surg, 2008, 122(5): 1451-1456.
16. Watanabe K. A simple method of osteosynthesis for avulsion fractures of the thumb metacarpophalangeal joint. Hand Surg, 2005, 10(2-3): 209-211.

Chinese Journal of Reparative and Reconstructive Surgery

TREATMENT OF ULNAR COLLATERAL LIGAMENT AVULSION FRACTURE OF THUMB METACARP-OPHALANGEAL JOINT USING A COMBINATION OF Kirschner WIRE AND SILK TENSION BAND

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