J Korean Soc Surg Hand.  2016 Dec;21(4):230-237. 10.12790/jkssh.2016.21.4.230.

Chronic Instability of the Carpometacarpal Joint of the Thumb after Trauma: A Report of 3 Cases

• Park SG
• Ko YJ

• KMID: 2364215
• DOI: http://doi.org/10.12790/jkssh.2016.21.4.230

Abstract

Posttraumatic instability of the carpometacarpal joint of the thumb are rarely reported. Consequently little is known about clinical and radiologic diagnosis, natural progress or treatment method. We report three cases of chronic instability of the carpometacarpal joint of the thumb treated with Eaton and Littler's ligament reconstruction. Satisfactory thumb functions were restored without arthritic change or recurrent subluxation.

Keyword

Thumb; Carpometacarpal joint; Anterior oblique ligament; Dorsoradial ligament; Instability; Ligament reconstruction

MeSH Terms

Carpometacarpal Joints*
Diagnosis
Ligaments
Methods
Thumb*

Figure

• 

  Fig. 1. Intraoperative photographs for the reconstruction of the volar oblique ligament according to the Eaton and Littler technique. (A, B) Radial half of the flexor carpi radialis was passed through a drill hole in the base of the first metacarpal bone. (C) It was placed beneath the abductor pollicis longus then passed around the remaining flexor carpi radialis and secured over the dorsal capsule.

• 

  Fig. 2. (A, B) Plain radiographs at 3 days after injury showed normal positioning of the carpometacarpal joint of the thumb with uniform joint space. (C) Antero-posterior radiograph of the wrist at 4 months after injury showed radially displaced carpometacarpal joint of the thumb. (D) Oblique radiograph of semipronated wrist at 4 months after injury showed widened interval between first and second metacarpal bone base and non-parallel joint space in comparison with initial radiograph.

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  Fig. 3. Two dimensional computed tomography coronal image suggested an air density (arrow) in the carpometacarpal joint of the thumb.

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  Fig. 4. (A) Radiograph demonstrating reduced carpometacarpal joint of the thumb with a hole at the metacarpal base made to pass the split of flexor carpi radialis tendon. (B) Follow-up radiograph at 23 months after the surgery shows congruent joint with no arthritis.

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  Fig. 5. (A, B) Follow-up photograph at 23 months after the surgery shows full range of motion in all planes.

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  Fig. 6. (A) Plain radiograph made at several days after injury in a local clinic showed normal alignment of the carpometacarpal joint of the thumb with uniform joint space. (B) Radiograph of the wrist at 1 year after injury showed radially displaced carpometacarpal joint of thumb. (C) Follow-up radiograph 18 months after the surgery showed sustained alignment with no arthritic change.

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  Fig. 7. (A, B) Follow-up photograph at 18 months after the surgery shows full range of motion in all planes.

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  Fig. 8. (A) Plain radiograph made after injury showed normal alignment of the carpometacarpal joint of the thumb with uniform joint space. (B) Radiograph of the wrist at 1 month after injury showed radially displaced carpometacarpal joint of the thumb. (C) Follow-up radiograph at 12 months after the surgery showed congruent joint space.

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  Fig. 9. T2 weighted magnetic resonance coronal image (A) and T1 weighted sagittal image (B) suggested no specific abnormal finding at volar oblique ligament (arrows) in the carpometacarpal joint of the thumb.

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