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The Journal of Bone and Joint Surgery, Vol 59, Issue 1 14-21, Copyright © 1977 by Journal of Bone and Joint Surgery, Inc
Post-traumatic instability of the metacarpophalangeal joint of the thumb
RJ Smith
Of eithty-six patients with collateral ligament instability of the
metacarpophalangeal joint of the thumb, sixty-six (77 per cent) had ulnar
and twenty (23 per cent) had radial instability, while in addition
twenty-four had fractures and twenty-nine had volar subluxation of the
proximal phalanx. Of the sixty-nine patients operated on, sixty-five had an
abnormality of the ulnar or radial collateral ligament proper or of its
attachment; two, subluxation of the extensor pollicis longus; and two,
stretching of the adductor expansion. Stability was restored by collateral
ligament repair or reconstruction, by fixation of a fracture fragment with
a Kirschner wire, or by arthrodesis in all but five thumbs. Of the five
patients who did not have stability of the metacarpophalangeal joint
following surgery, three had had the collateral ligament sutured more than
three weeks after injury and two had had reconstruction of the collateral
ligament using a tendon graft. Early surgical treatment is recommended for
all patients with post-traumatic instability of the metacarpophalangeal
joint greater than 45 degrees and for those with volar subluxation of the
proximal phalanx or a displaced fracture of the base of the proximal
phalanx. Collateral ligament repair is indicated for patients operated on
within three weeks of injury, and reconstruction of the ligament by means
of a tendon graft is recommended for those treated more than three weeks
after injury.
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