Collateral ligament avulsion fractures from the heads of the metacarpals of the fingers

Abstract

Nineteen patients with collateral ligament avulsion fractures from the metacarpal heads of the fingers were treated during a 6 year period. Seven undisplaced fractures were initially treated conservatively. Four united with full movement. Three required internal fixation for symptomatic non-union and healed without problems. Eleven patients with displaced fractures were treated by primary internal fixation using a single lag screw through a dorsal approach. Seven of these achieved a full range of movement of the injured digit by 3 months. Four patients failed to regain full flexion of the metacarpophalangeal joint. One patient with a displaced and comminuted fracture was treated with internal fixation at 8 weeks when the fragment had consolidated. As with similar fractures from the proximal phalangeal bases, these fractures are prone to non-union when treated conservatively, even when undisplaced. If fixation becomes necessary, the delay of a trial of conservative treatment does not appear to affect the outcome. Internal fixation of displaced fractures allows gentle mobilisation and facilitates union.