Instability Of Metacarpophalangeal Joint Research Articles

Bone-retinaculum-bone reconstruction for chronic posttraumatic instability of the metacarpophalangeal joint of the thumb

Purpose: This study presents an autograft technique for the surgical management of chronic posttraumatic instability of the thumb metacarpophalangeal (MCP) joint by using a bone-retinaculum-bone graft from the second compartment of the extensor retinaculum. Methods: The bone-retinaculum-bone graft was harvested from the second compartment. The graft ends were fixed into the host site with screws. Fourteen patients (12 ulnar, 2 radial collateral ligament tears) had the procedure. All patients were reviewed by an independent observer using objective and subjective criteria, the mean follow-up time was 20 months. Results: Results were satisfactory overall (8 excellent, 4 good, 1 fair, 1 poor that subsequently was fused). All patients returned to their former jobs. All but one had a clinically stable first MCP joint; grasp was 87%, pinch was 80%, MCP joint range of motion (ROM) was 91%, and interphalangeal joint ROM was 98% of the unoperated side. Conclusions: Early results are encouraging. This procedure preserves ROM of the MCP and interphalangeal joints of the thumb, improves strength, and gives the stability required for proper thumb function.

Grade III radial collateral ligament injuries of the thumb metacarpophalangeal joint: Treatment by soft tissue advancement and bony reattachment

Purpose: The purpose of this study is to report the results of intact radial collateral ligament (RCL) soft tissue sleeve advancement with bony reattachment without additional soft tissue reinforcement as the sole surgical repair technique for the treatment of grade III RCL injuries to the thumb metacarpophalangeal (MCP) joint in acute, chronic, and late cases. Methods: During a 20-year period, 38 of 45 patients (84%) with grade III RCL injuries were found to have tears at or adjacent to the metacarpal head (25 patients) or the proximal phalanx (13 patients) and underwent surgical repair at a mean of 10.8 months after injury. Patients were evaluated at a mean follow-up time of 3.8 years (minimum, 1 year), comparing pre- and postoperative standard thumb x-rays, varus (adduction) MCP joint stress x-rays, joint range of motion, pinch and grip strengths, clinical deformity, and subjective symptoms. Results: Thirty-three patients (87%) were symptom free. Thirty-five patients (92%) regained normal pinch and grip strength. Thirty patients (79%) had full range of motion at the MCP joint, and no patient lost any interphalangeal joint motion. No recurrent symptomatic MCP joint instability was noted. Three patients (8%) had mild residual asymptomatic MCP joint volar subluxation. One patient had progression of pre-existing degenerative joint changes. Conclusion: Acute, chronic, and late grade III RCL instability of the thumb MCP joint can be successfully treated in the majority of cases by RCL soft tissue sleeve advancement and bony reattachment alone without the need for other soft tissue reinforcement. (J Hand Surg 2003;28A:14-20. Copyright © 2003 by the American Society for Surgery of the Hand.)

The treatment of chronic thumb metacarpophalangeal joint instability in an adolescent secondary to thumb hypoplasia

A fourteen-year-old female presented with untreated thumb hypoplasia consisting only of chronic instability of the thumb metacarpophalangeal joint. Successful treatment consisted of metacarpophalangeal joint fusion.

Complications and bad results in pollicization of the index finger (in congenital cases)

While there is general agreement that pollicization is indicated in cases of complete thumb aplasia and Grade IV hypoplasia (floating thumb), there is continued discussion about the optimal management of lesser grades of hypoplasia, and of the five-fingered hand. In our opinion, the quality of a reconstructed thumb is determined by the quality of the digit from which it is made. Thus attempts at salvage of Grade III hypoplastic thumbs have been predictably disappointing. The absence of a carpometacarpal joint, portions of the metacarpal, and much of the intrinsic and extrinsic musculature, as well as metacarpophalangeal joint instability severely limit the resulting reconstructed thumb. Both functionally and cosmetically it will be inferior to a thumb achieved by ablation of the poorly functional digit and pollicization of a more normal index finger.