58: Skier’s Thumb: Repair of Acute Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament Injury

Procedure 58 Skier’s Thumb


Repair of Acute Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament Injury



imageSee Video 40: Repair of Acute Thumb MCP Joint Ulnar Collateral Ligament Injury


See Video 41: Thumb Radial Collateral Ligament Repair




Examination/Imaging





Surgical Anatomy




image The MCP joint has characteristics of both a condyloid and a ginglymus joint, which allow a relatively large range of motion. Consequently, there is little inherent stability in the bony architecture.


image Stability of the joint depends largely on a complex arrangement of ligamentous and musculotendinous structures.


image The ulnar collateral ligament is composed of two units. The proper UCL originates on the ulnar lateral condyle of the metacarpal and traverses obliquely to insert on the volar third of the ulnar proximal phalanx. It is tight in flexion and loose in extension. The accessory UCL originates volar to the proper collateral ligament and inserts on the ulnar sesamoid and volar plate. It is tight in extension and loose in flexion.


image The adductor pollicis inserts on the ulnar sesamoid embedded in the volar plate. It has an aponeurosis that extends obliquely across the MCP joint, inserting into the extensor mechanism distal to the sagittal bands.


image A Stener lesion results from a forceful radial deviation of the proximal phalanx, resulting in a distal avulsion of the UCL from its insertion on the proximal phalanx. Because of the extensive radial deviation of the proximal phalanx, the UCL becomes displaced from its insertion point deep to the adductor aponeurosis and comes to lie superficial and proximal to the adductor aponeurosis, which prevents the ligament from anatomic alignment. The lesion is created with forced radial deviation of the proximal phalanx with displacement of the UCL superficial to the adductor aponeurosis to prevent its anatomic alignment (Fig. 58-2).


image Branches of the superficial radial nerve often cross the operative field and need to be identified and protected.




Mar 5, 2016 | Posted by in Hand surgery | Comments Off on 58: Skier’s Thumb: Repair of Acute Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament Injury

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