Thumb Injuries Research Articles

Firecracker blast injury to the hand in children: Classification of the thumb injury and the functional outcome assessment

The study aimed to analyze the firecracker blast injury to the hand in children and assess the functional outcome. In addition, the article classified the firecracker blast injury pattern to the thumb in children. A retrospective cohort study was conducted between 2012 and 2020, analyzing 31 children sustaining firecracker blast injuries. The functional outcome was assessed. The author also proposed a classification based on the injury involving the webspace, flexor pollicis longus, thenar, adductor, and flexor muscles, neurovascular injury, and fractures/dislocations. There were 30 males and one female with a mean age of 6 years (range 2–13 years). The mean follow-up was 25 months (Range, 12–36 months). The author classified the injury into grades 1 (n = 9 children), 2 (n = 12), 3A (n = 8) and 3B (n = 2) based on the involved structures. All children had better functional outcomes following the reconstructive procedures based on the classification. The grades of injury did not significantly impact the functional outcome (p = 0.96). Despite the complexity and multitude of firecracker blast injuries, children performed better. The classification based on firecracker blast injury involving vital structures is simple, straightforward, and meaningful. It is helpful for decision-making at the first surgery and subsequent secondary reconstructive procedures. IV. • Firecracker blast injuries to the hand in children are complex and multitude in nature. • The vital structures are badly injured. • A new classification based on firecracker blast injury in children is vital. • It is helpful for decision-making at the first surgery and subsequent reconstructive procedures. • The functional outcomes are better in children's injuries.

Physical therapy recommendations for injury prevention in alpine skiing

Introduction: Alpine skiers face high speeds, significant forces, natural and unnatural obstacles, and various environmental conditions on the slopes. Thus, they are highly exposed to certain injuries, amongst which the most common are those to the knee followed by injuries to the spine, shins, head, as well as arm and thumb injuries. Purpose: The purpose was to systematically review the scientific literature on injuries, risk factors, and prevention in competitive alpine skiing and to provide recommendations for injury prevention in the field of physical preparation, kinesiotherapy, and/or specific exercises, and to determine which exercise program would be most appropriate for an alpine ski racer. Methods: PubMed, Web of Science, and COBISS databases were used with PRISMA method to review the physical therapy recommendations for injury prevention in alpine skiing. Results: 10 studies were included in the final systematic review. We have not found any evidence-based prevention programs that are not older than 10 years on the topic of physical preparation for alpine ski racers. We found that most often, the literature describes prevention in terms of equipment, course preparation, course safety awareness, and the experience of the skier. Conclusions: The recommendation for the most efficient prevention according to the current literature is to follow the above preventive measures in combination with appropriate physical preparation, where we recommend relying on research evidence in other (non-contact) sports that have similar injury mechanisms as alpine ski racing.

Tips for managing 4 common soft-tissue finger and thumb injuries.

After examination and, in some cases, imaging, most of these injuries can be managed conservatively with splinting or injection. Some cases require prompt surgical referral.

Second dorsal metacarpal artery-based index finger dorsal island flap for the management of thumb defects

Index finger dorsal island flaps were frequently utilized by hand surgeons to reconstruct thumb defects. However, the blood supply of the traditional index finger dorsal island flap comes from the first dorsal metacarpal artery, which has a smaller diameter, more anatomical variation, and can be injured in conjunction with thumb injuries. Therefore, we design an alternative index finger dorsal island flap based on the second dorsal metacarpal artery to treat thumb skin defects. From August 2015 to October 2018, we used the index finger dorsal island flaps with the second dorsal metacarpal artery to treat 11 patients with thumb skin defects. All the flaps and skin grafts survived completely without complications. At the last follow-up, the mean 2PD of the flap was 6.4mm (45.5% for excellent, 54.5% for good), the mean ROM of the injured thumbs was 115.9° (72.7% for excellent, 27.3% for good), and the mean cosmetics score was 8.6. Our results demonstrate that the index finger dorsal island flap with the second dorsal metacarpal artery is suitable for the reconstruction of thumb skin defects. The flap has an excellent survival rate and good coverage with satisfactory results and represents a promising treatment for the selected patients. Level of Evidence: Therapeutic, level IV.

Thumb Injuries and Instabilities. Part 2: Spectrum of Lesions.

The motor function of the thumb and its alignment with regard to the hand make it particularly vulnerable to trauma. Pathology encountered in this joint is varied, and imaging techniques play a crucial role in the diagnosis and characterization of injury. Despite advances in imaging technology, acute thumb injuries remain a challenge for radiologists. Currently, standard radiography and ultrasonography are frequently used first-line imaging techniques. Computed tomography is most often indicated for complex fractures and dislocations. Magnetic resonance imaging may be used to optimally characterize soft tissues and bone marrow. In this article, we cover the most common traumatic injuries: fractures, dislocations, collateral ligament injuries of the metacarpophalangeal joint, as well as soft tissue lesions.

Thumb Injuries and Instabilities. Part 1: Anatomy, Kinesiology, and Imaging Techniques of the Thumb.

The unique anatomical characteristics of the thumb offer a broad range of motion and the ability to oppose thumb and finger, an essential function for grasping. The motor function of the thumb and its orientation make it particularly vulnerable to trauma. Pathologic lesions encountered in this joint are varied, and imaging techniques play a crucial role in injury detection and characterization. Despite advances in diagnostic accuracy, acute thumb injuries pose a challenge for the radiologist. The complex and delicate anatomy requires meticulous and technically flawless image acquisition. Standard radiography and ultrasonography are currently the most frequently used imaging techniques. Computed tomography is most often indicated for complex fractures and dislocations, and magnetic resonance imaging may be useful in equivocal cases. In this article, we present the relevant anatomy and imaging techniques of the thumb.

A Modification to Enhance the Survival of the Island FDMA Flap by Adding a Skin Bridge.

Background:Distal thumb injuries are common in high construction load regions, and it is a challenging task for the plastic surgeon to find the optimum choice that preserves thumb length and provides a sensory substitute to the lost tissue. Introducing first dorsal metacarpal artery flap has solved the dilemma. One drawback is that the flap is susceptible to distal necrosis, which can happen because of tight tunneling or insufficient venous drainage. We combined Foucher and Holevich characteristics to design a flap that promises to solve the problem.Methods:This is a case series that includes 9 patients where we describe a technique that has the potential to enhance the survival of the first dorsal metacarpal artery (FDMA) flap and decreases the rate of distal necrosis via addition of a 5-mm skin bridge to the pedicle and by avoiding tunneling. Distal necrosis of the patients in this study patients was compared with that in a control of 10 patients in whom we did the conventional FDMA flap. Patients were followed for 6 weeks to trace early postoperative complications (infection, dehiscence, and necrosis) and the establishment of protective sensation (pain and temperature).Results:None of our patients had distal necrosis, infection, or dehiscence, and all had protective sensation in the flap. In comparison, 4 patients in the control group developed distal necrosis.Conclusion:FDMA is one of the best choices when it comes to distal thumb reconstruction, but it has the disadvantage of distal necrosis, which might be avoided when using the technique mentioned in this study.

Association of Interfacility Transfer and Patient and Hospital Characteristics With Thumb Replantation After Traumatic Amputation

Given that 40% of hand function is achieved with the thumb, replantation of traumatic thumb injuries is associated with substantial quality-of-life benefits. However, fewer replantations are being performed annually in the US, which has been associated with less surgical expertise and increased risk of future replantation failures. Thus, understanding how interfacility transfers and hospital characteristics are associated with outcomes warrants further investigation. To assess the association of interfacility transfer, patient characteristics, and hospital factors with thumb replantation attempts and success. This cross-sectional study used data from the US National Trauma Data Bank from 2009 to 2016 for adult patients with isolated traumatic thumb amputation injury who underwent revision amputation or replantation. Data analysis was performed from May 4, 2020, to July 20, 2020. Interfacility transfer, defined as transfer of a patient from 1 hospital to another to obtain care for traumatic thumb amputation. Replantation attempt and replantation success, defined as having undergone a replantation without a subsequent revision amputation during the same hospitalization. Multilevel logistic regression models were used to assess the associations of interfacility transfer, patient characteristics, and hospital factors with replantation outcomes. Of 3670 patients included in this analysis, 3307 (90.1%) were male and 2713 (73.9%) were White; the mean (SD) age was 45.8 (16.5) years. A total of 1881 patients (51.2%) were transferred to another hospital; most of these patients were male (1720 [91.4%]) and White (1420 [75.5%]). After controlling for patient and hospital characteristics, uninsured patients were less likely to have thumb replantation attempted (odds ratio [OR], 0.61; 95% CI, 0.47-0.78) or a successful replantation (OR, 0.64; 95% CI, 0.49-0.84). Interfacility transfer was associated with increased odds of replantation attempt (OR, 1.34; 95% CI, 1.13-1.59), with 13% of the variation at the hospital level. Interfacility transfer was also associated with increased replantation success (OR, 1.23; 95% CI, 1.03-1.47), with 14% of variation at the hospital level. In this cross-sectional study, interfacility transfer and particularly hospital-level variation were associated with increased thumb replantation attempts and successes. These findings suggest a need for creating policies that incentivize hospitals with replantation expertise to provide treatment for traumatic thumb amputations, including promotion of centralization of replantation care.

Evidence-based use of clinical examination, ultrasonography, and MRI for diagnosing ulnar collateral ligament tears of the metacarpophalangeal joint of the thumb: systematic review and meta-analysis.

To determine the performances of clinical examination, ultrasonography, and MRI for diagnosing non-displaced and displaced ulnar collateral ligament (UCL) tears. Based on a literature search of Medline, ISI Web of Science, Embase, and Scopus between January 1990 and December 2019, all published original articles which met the inclusion criteria were included. We determined the pooled sensitivities, specificities, and accuracies of clinical examination, ultrasonography, and MRI using a meta-analysis based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Diagnostic Test Accuracy (PRISMA-DTA) guidelines. A total of 17 studies with 519 subjects reporting diagnostic performances of clinical examination (8), ultrasonography (12), and MRI (5) met the inclusion criteria. For ruling out UCL tears, the pooled sensitivities were similarly high for clinical examination (97% (95% confidence interval [CI], 93-99%)), ultrasonography (96% (95% CI, 94-98%)), and MRI (99% (95% CI, 92-100%)) (p = 0.3). For ruling in UCL tears, the pooled specificities were higher for MRI (100% (95% CI, 87-100%)) when compared to ultrasonography (91% (95% CI, 86-95%)) (p = 0.1) and clinical examination (85% (95% CI, 78-91%)) (p = 0.04). For the diagnosis of displaced UCL tears, MRI had a higher specificity (92% (95% CI, 73-99%)) than ultrasonography (72% (95% CI, 63-80%)) (p = 0.2). Clinical examination, ultrasonography, and MRI have similarly high sensitivities for ruling out UCL tears in patients presenting with a thumb injury. MRI and ultrasonography have high specificities to confirm the presence of suspected UCL tears. MRI performs best for differentiating non-displaced from displaced UCL tears. • Clinical examination followed by ultrasonography is the most appropriate test for ruling out ulnar collateral ligament (UCL) tears of the thumb. • MRI and ultrasonography both have high specificities to confirm the presence of a suspected UCL tear. • MRI outperforms ultrasonography for differentiating non-displaced from displaced UCL tears.

Caso clínico: Lesão de Stener no Futebol. A Importância da Ecografia na Decisão Clínica

Ligament thumb injuries are uncommon in professional or amateur football. In this paper, we discuss the physical examination and the choice of imaging tests for the diagnosis of Stener’s injury in an amateur goalkeeper. Traditionally, the hand radiography is the first image exam performed, and it may fail because it does not diagnose ligament injury. Ultrasound is more sensitive than conventional radiography for the diagnosis of these lesions and it does not use ionizing radiation and is widely available. Therefore, its use in the medical departments of clubs and hospitals should be encouraged as a first-line exam.

Caso clínico: Lesão de Stener no Futebol. A Importância da Ecografia na Decisão Clínica

Ligament thumb injuries are uncommon in professional or amateur football. In this paper, we discuss the physical examination and the choice of imaging tests for the diagnosis of Stener’s injury in an amateur goalkeeper. Traditionally, the hand radiography is the first image exam performed, and it may fail because it does not diagnose ligament injury. Ultrasound is more sensitive than conventional radiography for the diagnosis of these lesions and it does not use ionizing radiation and is widely available. Therefore, its use in the medical departments of clubs and hospitals should be encouraged as a first-line exam.

Cobertura de partes blandas del Pulgar. Guía en la toma de decisiones

Digital injuries are frequent in medical practice. When they involve the thumb, it is important to consider that an amputation affects up to 50% of the hands’ function and decreases its strength by up to 20%. Management of thumb injuries often requires coverage with local flaps, which are not always performed by hand surgeons. Choosing the right flap is essential to avoid restrictions in mobility and functional limitations of the injured finger. Our objective is to summarize and provide a strategy for the analysis of thumb injuries that may help to understand the different types of lesions, and the surgical approaches recommend in order to optimize coverage and long term results.Evidence Level: IV

A Challenging Thumb Injury

A Challenging Thumb Injury

Indications and functional outcome of the use of integra® dermal regeneration template for the management of traumatic soft tissue defects on dorsal hand, fingers and thumb

Few studies have been conducted to explore the utility of the Integra® dermal regeneration template (IDRT) combined with a delayed split-thickness skin graft (STSG) for reconstructing complex dorsal hand, digit, and thumb injuries. This study reports the indications and outcomes for 14 patients treated with this technique via a two-stage process. We retrospectively reviewed all patients treated by IDRT combined with STSG from May 2015 to October 2018. The inclusion criterion was traumatic or post-infectious soft tissue defects (STDs) of the dorsal hand, fingers, and thumb, not suitable for direct wound closure and requiring local, pedicle, or free flap reconstruction. After debridement, a two-stage procedure was applied, namely IDRT followed by STSG. Indications, functional outcomes, aesthetic results, complications, patient satisfaction, and the STSG take rate were evaluated over a 36-month follow-up using standardised instruments. A total of 14 patients with 15 reconstructions (average age = 48years) were included. The dominant hand was involved in 50% of cases. Dorsal STDs involved the hand, fingers, thumb, and hand and thumb in 7, 3, 2 and 2 cases, respectively. The mean STD size was 35cm2 (range: 3-150cm2). The wound was associated with exposed tendons (without peritenon), bone (without periosteum), and joints (without a capsule) in eight cases (57%). The IDRT/STSG take rate was 97%. The average Vancouver Scar Scale score was 2 (1-4). The 36-month follow-up demonstrated that IDRT is a safe and reliable technique that can be considered a viable alternative to flap reconstruction for the management of traumatic STDs in selected patients. The aesthetic outcomes are acceptable, functional recovery of the fingers is excellent, patient satisfaction is very high and the rate of complications is very low.

Arterial or venous free flaps for volar tissue defects of the proximal interphalangeal joint: A comparison of surgical outcomes.

BackgroundFor volar soft tissue defects of the proximal interphalangeal (PIP) joint, free flaps are technically challenging, but have more esthetic and functional advantages than local or distant flaps. In this study, we compared the long-term surgical outcomes of arterial (hypothenar, thenar, or second toe plantar) and venous free flaps for volar defects of the PIP joint.MethodsThis was a single-center retrospective review of free flap coverage of volar defects between the distal interphalangeal and metacarpophalangeal joint from July 2010 to August 2019. Patients with severe crush injuries (degloving, tendon or bone defects, or comminuted/intra-articular fractures), thumb injuries, multiple-joint and finger injuries, dorsal soft tissue defects, and defects >6 cm in length were excluded from the study, as were those lost to follow-up within 6 months. Thirteen patients received arterial (hypothenar, thenar, or second toe plantar) free flaps and 12 received venous free flaps. Patients’ age, follow-up period, PIP joint active range of motion (ROM), extension lag, grip-strength ratio of the injured to the uninjured hand, and Quick Disabilities of Arm, Shoulder & Hand (QuickDASH) score were compared between the groups.ResultsArterial free flaps showed significantly higher PIP joint active ROM (P=0.043) and lower extension lag (P=0.035) than venous free flaps. The differences in flexion, grip strength, and QuickDASH scores were not statistically significant.ConclusionsThe surgical outcomes of arterial free flaps were superior to those of venous free flaps for volar defects of the PIP joint.

Cross-finger Flap to the Thumb: Quest for an Alternate Donor.

Background Distal thumb injuries are managed by multiple local and regional flaps. The cross-finger flap (CFF) is one versatile flap used to cover such defects. The donor finger to the thumb is classically described to be the index finger (IF). However, with the index finger being the second most important finger, it causes further debilitation of the already injured hand. Our aim was to find an alternate donor finger to spare the index finger. Methods and Materials A prospective observational study was conducted on 10 patients with distal thumb injuries who were admitted between November 2018 and July 2019. Ring finger (RF) was used as donor for CFF in all the cases. The subjects were assessed for first web space angle, Kapandji score, total range of movement (TRM) of long fingers, and global hand function using Michigan hand outcome questionnaire (MHQ) after flap division. Results There was no first web contracture and TRM of IF remained unaffected. However, TRM of RF was significantly reduced. But this being a relatively unimportant finger, there was no significant reduction in global hand function, as evaluated by the MHQ score. Conclusion The ring finger is a good alternative for index finger as donor for CFF to the thumb, because it provides adequate tissue along with comfortable positioning and easy maintenance of local hygiene. Moreover, it preserves global hand function by sparing the IF.

HAND INJURY

HISTORY: A 15 year old H.S. football quarterback sustained a right thumb injury while throwing a pass. His hand hit a defender’s chest during follow through, jamming his thumb. He noted swelling and bruising over thenar eminence and his 2nd MCP joint. This resulted in limited ROM of the right thumb especially of abduction and opposition. PHYSICAL EXAMINATION: Examination of the right hand showed edema along the 1st MCP joint, thenar eminence with ecchymosis in 1st webspace extending into 2nd MCP joint. Skin was intact. Thumb was well vascularized. No tenderness over 2nd metacarpal or 2nd MCP joint. Thumb opposition and 1st MCP flexion and extension less than 20° were limited by edema and pain, IP ROM was within functional limits. Tenderness over ulnar aspect of 1st MCP joint . Pain and tenderness present during MCP extension with mild laxity with UCL stressing. Laxity at the CMC joint with some dorsal subluxation, reducible. Tenderness proximal to trapezium. Contralateral side thumb revealed also some laxity at the CMC. DIFFERENTIAL DIAGNOSIS: 1. Fracture of the right 1st Metacarpal bone 2. Fracture of the right thumb proximal phalanx 3. Fracture of the wrist bones 4. Right 1st MCP joint UCL sprain TEST AND RESULTS: X-rays of the right hand 3V: No bony or soft tissue abnormalities. MRI right hand ordered to rule out occult fracture(s), ligament tears : 1. Nondisplaced fracture of the trapezium. Diffuse bone marrow contusion in the 1st metacarpal with small avulsion fragment of the radial metacarpal at RCL attachment 2. Bone contusion of the distal dorsal capitate 3. Moderate grade sprain of UCL and RCL at the thumb MCP joint with partial tearing of proximal RCL at the avulsion fragment. 4. Diffuse low grade muscle strain with superimposed partial musculotendinous tear of flexor pollicis brevis muscle. TREATMENT AND OUTCOMES: 1. Wrist and thumb immobilization in Custom thumb spica splint to enable graduated ROM as tolerated and Occupational Therapy 2. Restriction from all contact sports for 6 weeks 3. Consultation with Hand Orthopedist to evaluate for surgical necessity determined patient to be appropriate for conservative treatment. Patient seen in Sports Medicine Clinic 39 days after initial injury. Returned to sports after 6 weeks of immobilization with thumb/wrist taped . Patient denied pain with activity.

Hand Injury - Basketball

HISTORY: 16-year-old male presenting with left thumb injury. Patient presented due to thumb injury during basketball 5 weeks prior to presentation. He reported a basketball was thrown extremely hard and hit him on the lateral side of the thumb, pushing his thumb towards his 5th digit. Despite pain, he was able to finish the game. He had noticeable swelling when the game ended. Despite icing, he continued to have swelling in addition to pain with pinching items or texting. This led him to the urgent care 1 week prior to presentation. X-rays were obtained at the urgent care and he was sent to sports medicine clinic. PHYSICAL EXAMINATION: Examination of left hand showed noticeable deformity at MCPJ, with proximal phalanx appearing subluxed on MC. Flexible deformity on radial aspect of the thumb MCP joint. Tenderness to palpation over the radial side of the MCP joint where there is a prominence. No swelling or bruising. Full range of motion of the thumb without limitation. Strength 4/5 with thumb flexion, extension, abduction, adduction. Pain with thumb manual muscle strength testing. Stable to UCL stress at 0 and 30 degrees. RCL laxity at 0 and 30 degrees without clear endpoint. Normal thumbs up and okay sign. Normal thumb to pinky opposition. Normal grip. Neurovascularly intact. DIFFERENTIAL DIAGNOSIS: 1.Radial collateral ligament tear 2.Flexor pollicis brevis tear 3.1st proximal phalanx fracture 4. Sesamoid fracture TESTS AND RESULTS: XR Left Hand Impression: No fractures identified. Subluxation of thumb at MCP joint. MRI Left Hand Impression: Complete disruption of radial collateral ligament of the MCP joint of the thumb with ulnar subluxation of the phalanx compared to the metacarpal. Significant joint fluid. Ulnar deviation of the flexor policis longus and sesamoids. Some marrow edema of the distal metacarpal as well as subchondral bone of first phalanx. FINAL/WORKING DIAGNOSIS: Chronic radial collateral ligament rupture at metacarpal level TREATMENT AND OUTCOMES: 1.Surgical radial collateral ligament repair 2.Initially immobilized with thumb spica splint 3.Casted from 1-5 weeks post operatively 4.Out of cast at 5 weeks post op out; into OT formed hand-splint and range of motion exercises started 5.Follow up planned 9 weeks post-op. Work with OT to achieve full, painless ROM and normal strength prior to returning to basketball

Flexor pollicis longus tendon retrieval using silicone rods; is it worth it?

The hand represents one of the most common sites for injuries in a trauma setting. Hand mobility, the arc of motion away from the body, and being involved in many of the daily activities add to this high incidence. Thumb injuries carry a substantial burden on hand function due to its mobility, distinctive motion patterns, and particular purposes it attains. This is a prospective case-control study for cases presented to the emergency department at Kasr Al-Ainy, school of medicine, Cairo University, for the period between January 2018 and July 2019, with zone II (T2) flexor pollicis longus (FPL) tendon injuries. Patients were divided into two groups: one group had FPL retrieved with the aid of silicone rods using a different wrist incision and the other group had a retrieval done through the same site of injury without the use of rods. Patients were followed up paying attention to their rehabilitation progress, return-to-work time, and complications (e.g., rupture and infections). Patients with comorbidities (e.g., diabetes mellitus), hand infections, or associated fractures were excluded from the study. One hundred patients were included in this study. Randomly, 50 patients were assigned to group A and 50 patients to group B. The age range was 16 to 75 years. Eighty percent of the patients were males, and the remaining 20% were females. Follow-up period ranged from 3 months to 1 year with a mean follow-up period of 8 months. Group A showed shorter operative time (P value < 0.001), faster return to work (P value < 0.001), and lower complication rates (P value < 0.07) than group B. The use of silicone rods represents a suitable method for FPL tendon repair with faster recovery, lower complication rates, and shorter operative times. Level of evidence: Level IV, therapeutic study.

Pull-out tehnika reparacije ulnarnog kolateralnog ligamenta palca

Introduction: Ulnar collateral ligament (UCL) of the thumb injury is a very common injury. However, due to the complexity of the ligament anatomy, the inexperience of doctors and unavailability of diagnostic procedures, the ulnar collateral ligament of the thumb injury is most commonly overseen. The consequences are loss of thumb function, instability and pain in the metacarpophalangeal joint, and accelerated osteoarthrosis. For these precise reasons, there is a clear consensus that this injury should be treated operatively. Objective: The objective of this paper is to present the results of the pull-out technique for reconstructing the UCL ligament. Methodology: In between 2018 and 2020, we have operated on 11 patients with the UCL of the thumb rupture in our department. We approached the dorsoulnar side of the metacarpophalangeal (MCP) joint of the thumb using the standard lazy S incision. In 9 out of 11 patients, a Stener ligament lesion was discovered. All patients had their ligament reconstructed using the pull-out technique, where the ligament was sewn through, then guided through a channel created using a K needle on the radial side of the base of the thumb. Postoperatively, a spica plaster orthosis was placed on the thumb. Results: The patients returned for re-evaluation 6, 12 and 24 weeks after surgery. Upon 24 weeks, the patients had no complaints regarding their thumb, they had full grip strength and could perform all the various grips. Two of the patients had a limited abduction amplitude of the thumb in the MCP joint, which didn't affect the outcome. There was no injury to the sensory branch of the radial nerve. Conclusion: The pull-out technique is a safe, quick and cheap operative technique for UCL of the thumb reconstruction.