Arch Hand Microsurg.  2019 Jun;24(2):142-151. 10.12790/ahm.2019.24.2.142.

Mini Hook Plate Fixation for the Thumb Ulnar Collateral Ligament Fracture-Avulsion

• Lee SY
• Woo SH
• Kang HJ

• KMID: 2448048
• DOI: http://doi.org/10.12790/ahm.2019.24.2.142

Abstract

PURPOSE
Ulnar collateral ligament (UCL) avulsion fractures of thumb metacarpophalangeal joint (MCPJ) involve small bony fragments that are usually attached to structures that are necessary for stability or movement of the joint. Satisfactory reduction can be difficult because of the small size of the fragments. The aim of this article is to analyze outcomes of this technique.
METHODS
We used a 1.2 mm titanium hook plate in seven patients with thumb UCL avulsion fracture of MCPJ, with a mean age of 33 years. The mean time from injury to operation was 13 days. Bone union was determined through radiographs. Clinical outcomes were evaluated by assessing range of motion (ROM) of the thumb MCPJ, pinch strength, grip strength, the visual analogue scale (VAS), and Korean version of the Michigan Hand Outcomes Questionnaire (K-MHQ) score.
RESULTS
All patients achieved bone union within 3 months and mean follow-up period was 14.3 months. The postoperative ROM and VAS pain score improved. Grip and pinch strength were lower than the other hand but not statistically significant. No instability was observed. In addition, postoperative K-MHQ scores showed good results. One patient underwent hardware removal because of skin irritation and abnormal sensation. There were no other complications.
CONCLUSION
Mini hook plate fixation technique produced stable fixation and showed good clinical and radiologic outcomes in avulsion fracture of thumb MCPJ.

Keyword

Thumb; Ulnar collateral ligament; Avulsion fractures; Hook plate fixation

MeSH Terms

Collateral Ligaments*
Follow-Up Studies
Hand
Hand Strength
Humans
Joints
Metacarpophalangeal Joint
Michigan
Pinch Strength
Range of Motion, Articular
Sensation
Skin
Thumb*
Titanium
Titanium

Figure

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  Fig. 1. The Medartis APTUS® 1.2-mm titanium hand plate and screws.

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  Fig. 2. Mini hook plate holder.

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  Fig. 3. A 35-year-old female sustained an outstretched injury of the left thumb metacarpophalangeal joint. (A, B) A preoperative plain radiographs showed displaced 1st proximal phalanx base fracture (white arrows). (C) Ulnar collateral ligament (UCL) avulsion fracture with Stener lesion was observed on the 1st metacarpophalangeal joint on magnetic resonance imaging (white arrowhead). (D, E) The UCL avulsion fragment was located above the adductor aponeurosis (black asterisk). After capsule opening, the bone fragment was reduced via hook plate fixation. The surrounding soft tissues were well repaired. (F-H) Postoperative images showed stable fixation of the bone fragment. (I) At 3 months postoperatively, X-ray was well maintained and recovered to full range of motion without pain.

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  Fig. 4. A 42-year-old male sustained an outstretched injury of the left thumb metacarpophalangeal joint. (A, B) A preoperative plain radiographs showed displaced 1st proximal phalanx base fracture (white arrows). (C) Ulnar collateral ligament (UCL) avulsion fracture and UCL injury from metacarpal head was observed on the 1st metacarpophalangeal joint on magnetic resonance imaging (white arrowhead). (D, E) Bone fragment (black asterisk) was reduced via hook plate fixation. UCL rupture was repaired with one suture anchor. After all procedures, surrounding soft tissues were well repaired (black arrows). (F-I) Postoperative images showed stable fixation of the bone fragment. (J) At 6 months postoperatively, X-ray was well maintained and recovered to full range of motion without pain.

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  Fig. 5. Use of hook plate for radial collateral ligament avulsion fracture of thumb metacarpophalangeal joint (arrows).

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