Avulsion Of Collateral Ligament Research Articles

Kirschner wire stabilization of collateral ligament avulsion fractures of the base of the proximal phalanx

Kirschner wire stabilization of collateral ligament avulsion fractures of the base of the proximal phalanx

Combined surgical treatment for missed rupture of triceps tendon associated with avulsion of the ulnar collateral ligament and flexor-pronator muscle mass

Triceps tendon ruptures are rare injuries. Coexistence of ipsilateral ulnar collateral ligament injury is even rarer. Here, we describe an unusual combination injury to elbow of a 39-year-old male construction worker consisting of triceps tendon rupture, avulsion of elbow ulnar collateral ligament and flexor pronator muscle origin ipsilaterally. A simultaneous repair and reconstruction of all damaged structures was proposed with individualized postoperative rehabilitation. Return to pre-injury level of activities obtained with this treatment protocol. High degree of suspicion and careful examination were needed to prevent missed diagnosis and prolonged instability which may be inevitable after inappropriate treatment of such injury.

SIMULTANEOUS METACARPOPHALANGEAL JOINT ULNAR COLLATERAL LIGAMENT INJURY AND CARPOMETACARPAL DISLOCATION OF THE THUMB IN A FOOTBALL PLAYER: A CASE REPORT

An unusual case of ulnar collateral ligament avulsion in association with carpometacarpal dislocation of thumb is described. Symptoms and deformity caused by dislocation can mask the presence of injuries such as damage to the ulnar collateral ligament of thumb. This may lead to long term disability. A high index of suspicion and good clinical examination allows correct diagnosis and management of these uncommon injuries leading to a good clinical outcome.

Delayed Anatomical Repair of Ruptured Ulnar Collateral Ligament Injuries of the Thumb Using a Dissolvable Polylactic Acid Bone Anchor

We describe late anatomic repair of complete distal ulnar collateral ligament (UCL) avulsions of the thumb in the absence of metacarpophalangeal joint arthritis using a dissolvable polylactic acid (PLA) bone anchor in two cases, one of which had a Stener lesion. Patients presented for surgery respectively at 5 months and 2 years after injury. Preoperative X-ray films showed subtle volar subluxation of the proximal phalanx. Volar plate release corrected this in both cases and a transarticular k-wire was not used. Satisfactory repair was achieved in both cases using a dissolvable PLA bone anchor. Flexion-extension mobilization was supervised by a hand therapist from day 1 after surgery. A low profile radial-sided thermoplastic splint to prevent reinjury of the UCL repair was used allowing interphalangeal joint and base of thumb movement, and was worn between therapy sessions for 4 weeks. In both patients, satisfactory UCL stability was maintained at 3-year follow-up after surgery. Dissolvable PLA bone anchors may be used to satisfactorily restore stability and function in late presenting complete distal UCL avulsions of the thumb with or without accompanying Stener lesions.

Traumatic Valgus Instability of the Elbow: Pathoanatomy and Results of Direct Repair

The medial collateral ligament provides valgus stability to the elbow. The purpose of the present study was to describe the pathoanatomy of acute traumatic medial collateral ligament ruptures and to report the rationale and results of direct repair. Between 1996 and 2006, eleven athletes presented with acute rupture of the medial collateral ligament of the elbow and no history of dislocation. Three patients had received steroid injections for the treatment of medial epicondylitis, but none had a history of medial elbow insufficiency. All patients demonstrated gross valgus instability on clinical examination and medial joint space widening on valgus stress radiographs. Complete avulsion of the medial collateral ligament from its humeral origin was documented with magnetic resonance imaging in all patients. Operative findings uniformly demonstrated avulsion of the flexor-pronator muscles with distal retraction. The underlying medial collateral ligament was avulsed in a sleeve-like fashion from the denuded medial epicondyle. The ligament was directly reattached to its footprint. The avulsed flexor-pronator tendon was repaired to the residual tendon with use of interrupted figure-of-eight nonabsorbable sutures. All patients were followed for a minimum of sixteen months with serial clinical examinations, radiographs, and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Full active range of motion was achieved in ten patients; the remaining patient had a 20 degrees flexion contracture. Three patients had acute ulnar nerve palsies at the time of the injury, and all three recovered complete motor and sensory function by six months after the injury. Nine of the eleven patients returned to competitive college athletics between four and six months. The mean DASH score at the time of the most recent follow-up was 6. Direct repair of an acute traumatic medial collateral ligament avulsion of the elbow reliably restores valgus stability, even in throwing athletes.

A Complete Radial Collateral Ligament Avulsion of the Small Finger Metacarpophalangeal Joint with Displacement through the Radial Sagittal Band

A displaced complete radial collateral ligament avulsion with associated injury to the sagittal band of the metacarpophalangeal joint of the small finger, if left untreated, may result in chronic pain, instability, weakness, and deformity. A case of a displaced radial collateral ligament that ruptured through the radial sagittal band of the small finger, with resultant injury to the extensor mechanism, is described and discussed with a review of the literature. Proper identification of this injury by physical exam and imaging studies along with surgical repair is associated with good outcome.

Medial Collateral Ligament Avulsion from Both Tibial and Femoral Attachments: A Case Report

The medial collateral ligament (MCL) is the most commonly injured ligament of the knee joint. Proximal MCL tears occur more frequently than do distal ones. We report a 28-year-old man with a valgus injury of his left knee joint after a fall from a motorcycle. Magnetic resonance imaging of the affected knee joint revealed complete avulsion of the superficial MCL from both its femoral and tibial insertions. The meniscofemoral portion of the deep part of the MCL was also torn and the medial meniscus was subluxated. Such a pattern, an MCL tear with subluxation of the medial meniscus, is rare.

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

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.

Failure of cast immobilization for thumb ulnar collateral ligament avulsion fractures

To determine if small avulsion fractures of the thumb ulnar collateral ligament (UCL) with minimal (< or = 2.0 mm) displacement can successfully be treated by cast immobilization, the authors reviewed 9 patients with minimally displaced fractures initially treated by casting. Despite immobilization within an average of 2 days of the initial injury (range, 0-6 days), a minimum of 6 weeks of immobilization in a cast, and adequate rehabilitation, all 9 patients had persistent thumb pain, especially with activities requiring strong pinch. After undergoing open reduction and internal fixation, the patients had relief of thumb pain and pinch strength improved from 36% of the contralateral side to 89% (p < .01). Grip strength increased from 77% to 93% (p < .05), but the ranges of motion of the thumb metacarpophalangeal and interphalangeal joints were not significantly altered. Minimally displaced UCL avulsion fractures frequently have significant rotation that prevents successful fracture healing even with prompt cast immobilization.

Acute Grade III ulnar collateral ligament ruptures

A review is presented here of 36 cases, seen since 1980, of acute Grade III (unstable) sports-related sprains of the thumb metacarpophalangeal joint. In all cases, the injury involved the ulnar collateral ligament. A Stener lesion was present in 97% of cases. Followup was from 2.0 to 8.5 years, the average being 3.9 years. All of the patients underwent repeat examination and radiography at followup. The first seven patients were treated by "traditional" pull-out suture and K-wire fixation, put into a cast for 4 weeks, and then gradually mobilized over 4 additional weeks. Thereafter, a "new method" was used. Avulsed ulnar collateral ligament stumps were sutured to the tendinous insertion of the adductor pollicis or to a soft tissue remnant using strong suture material. Large bony avulsions were pinned; small fragments were excised and the ligament was repaired. This latter method of repair was quite strong and allowed rapid mobilization: only 2 weeks in a cast, then a hand-mounted thumb spica orthosis was used while therapy progressed. Of the patients treated with the new method, 84% had excellent results and, overall, were able to return to sports sooner than patients treated with the traditional method. Pain, stability, and strength were corrected equally between groups; however, strength was restored more rapidly in the new method group. Range of motion was reduced equally in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Irreducible dorsoulnar dislocation of the proximal phalanx of the thumb

A case of irreducible complete dorsoulnar dislocation of the proximal phalanx of the thumb is presented. The pathologic anatomy included intersubstance tears of the ulnar collateral ligament and dorsal capsule and avulsions of the palmar plate and radial collateral ligament from their metacarpal attachments. The palmar plate blocked reduction, as did the radial collateral ligament that was caught on the margin of a tear in the adductor aponeurosis and on the tendon of the extensor pollicis longus. A review of the English-language literature indicates that this pathologic anatomy has not been described.

Anterior Dislocation of the Proximal Interphalangeal Joint

Five acute and chronic dislocations of the proximal interphalangeal joint were observed. All were associated with ruptures of the central slip of the extensor mechanism as shown by surgical exploration or the appearance of a boutonniere deformity after treatment. A study of the pathomechanics of this lesion in thirty fresh cadaver fingers indicated that the lesion is produced by a combination of a varus or valgus force and an anteriorly directed force on the base of the middle phalanx. Avulsion of collateral ligament, a tear of the volar plate, and rupture of the central slip are associated with the dislocation. Based on these findings and our experience with two surgically treated dislocations, procedures for the treatment of acute and chronic dislocations are proposed. The acute lesion should be treated by open reduction, fixation of the proximal interphalangeal joint in full extension with a transfixing Kirschner wire, and repair of the torn central slip, collateral ligament, and volar plate. The chronic lesion should also be reduced and fixed with a transfixing wire. However the volar plate must be excised before reduction is possible. The central slip and collateral ligaments must then be reconsitituted.

The treatment of avulsion of the collateral ligaments of the knee

1. 1. Six cases of avulsion of the collateral ligaments of the knee including two lateral dislocations are presented. 2. 2. In five cases early exploration and suture of the avulsed ligaments were carried out with prompt restoration of function and minimal permanent disability. 3. 3. Conservative treatment of one dislocation by prolonged immobilization in plaster after reduction resulted in loss of full flexion of the knee. 4. 4. Diagnostic manipulation under anesthesia is recommended for severe knee injuries, particularly those which do not exhibit effusion. 5. 5. Complete collateral ligament avulsions should be explored and repaired within a few days of injury. The procedure carries little risk, establishes the diagnosis with precision and lessens disability both in time and degree. 6. 6. Obvious dislocation of the knee should be reduced at the earliest possible moment. Associated injury to the popliteal artery takes the highest priority in treatment and exposure with resection or replacement of the damaged vessel should not be delayed