Locking of the Metacarpophalangeal Joint of the Thumb Caused by a Fracture Fragment of the Radial Condyle of the Metacarpal Head after Dorsal Dislocation

2006 ◽  
Vol 31 (6) ◽  
pp. 635-636 ◽  
Author(s):  
H. HIRATA ◽  
M. TSUJII ◽  
E. NAKAO

We report a case of a locked thumb metacarpophalangeal joint secondary to metacarpal head fracture. As fractures of the radial condyle are not readily seen in routine X-rays, other imaging modalities, including CT, should be considered if the patient complains of limited extension after hyperextension injury of the thumb.

2009 ◽  
Vol 34 (3) ◽  
pp. 358-362 ◽  
Author(s):  
G. J. S. LIM ◽  
A. YAM ◽  
S. C. TAY ◽  
F. C. YONG ◽  
L. C. TEOH

Kessler’s extensor pollicis brevis (EPB) palmar tendon sling is a simple and reliable reconstruction for symptomatic palmar instability of the thumb metacarpophalangeal (MP) joint. However, we encountered subluxation of the extensor pollicis longus tendon and extension lag at the MP joint when the entire tendon was used. We modified the technique, splitting the tendon to preserve its function as an MP joint extensor. Six thumb MP joints with anteroposterior instability secondary to hyperextension injury were reconstructed using the split-EPB technique. At an average of 22 months postoperatively, all patients had stable and pain-free MP joints. Pinch strength improved an average of 5.6 kg. MP joint flexion was decreased an average of 17.5° and two patients had flexion contractures of 5° and 20°, respectively. Extensor pollicis longus subluxation and MP extension lag did not occur, and there were no recurrences.


2019 ◽  
Vol 12 (01) ◽  
pp. 62-66
Author(s):  
Yoshifumi Harada ◽  
Atsuyuki Inui ◽  
Yutaka Mifune ◽  
Hanako Nishimoto ◽  
Takeshi Kokubu ◽  
...  

AbstractLocking of the thumb metacarpophalangeal joint is a relatively rare condition. We report successful treatment in 11 cases of locking of the thumb. Ten patients were diagnosed at an average of 3.2 days (range: 0–21 days) from the injury onset, whereas one patient was diagnosed at 4 months from the injury. Seven of 11 cases underwent successful manual reduction, whereas the other four cases required surgical treatment. Among the surgically treated cases, all cases had a sharp prominent of the radial condyle of the metacarpal head. Therefore, this case series showed 1 chronic case and 4 of 10 cases with a nonround shape of metacarpal heads requiring open reduction.


2018 ◽  
Vol 6 (6_suppl3) ◽  
pp. 2325967118S0005
Author(s):  
Ana Costa Pinheiro ◽  
Filomena Ferreira ◽  
Margarida Areias ◽  
Carolina Oliveira ◽  
Cristina Sousa ◽  
...  

Introduction: Injuries from the athlete’s hand are frequent. We present 2 clinical cases: Stener injury and traumatic dislocation of the metacarpophalangeal joint of the thumb. The “skier’s thumb” is an injury to the ulnar collateral ligament of the metacarpophalangeal joint of the thumb produced by abduction and hyperextension of the thumb. Dorsal dislocation of the thumb metacarpophalangeal joint (MCP) in children is a rare entity. There are three types of dislocation: incomplete, simple and complete complete complex. Methods: Presentation of 2 clinical cases of injuries of the athlete’s hand: Stener injury and traumatic dislocation of the metacarpophalangeal joint of the thumb. Retrospective descriptive method with reports of clinical cases based on patients’ electronic clinical processes. Results: CASE 1: Male 11 years old, put into service urgency by hand trauma during football match. He had pain and swelling at the ulnar rim of the joint of the first metacarpal-phalangeal joint. Radiogram unchanged. Coping with clinical suspicion was carried out ray under stress (radial deviation) showed that this instability of the joint. Ultrasonography confirmed complete rupture of the ulnar side of the attachment with the aponeurosis interposition of the adductor - stener lesion. Surgery decided. Focus through internal and distal reinsertion. 4 weeks immobilization period, followed by a return to activities of daily living. At the last visit, at 6 months after the operation there was no residual instability. CASE 2: Seven-year-old boy put into service urgency for thumb injury in hyperextension during football match. The objective examination shows hyperextension deformity of MCF. The radiological study confirmed complete MCF dorsal joint dislocation diagnosis of the thumb joint. A closed reduction procedure under sedation, by McLaughlin corset technique. Immobilization was performed for two weeks. At six weeks he was asymptomatic, with normal mobilities, symmetrical grip and clamp strength without instability or radiographic changes. Discussion/Conclusion: Lesion of the ulnar side ligament is a possible diagnosis of the pediatric age, even without associated withdrawal. Proper clinical observation and x-rays provide supplemented by ultrasound, often all the information necessary for diagnosis and therapeutic decision. The low frequency relevance of pediatric Stener injuries can damage your diagnosis of the emergency situation. In this clinical case, it is possible to detect this damage. The dislocations dorsal joint MCP thumb are more frequent than flying, lesional mechanism involving the traumatic hyperextension of it. The diagnosis is based on clinical information supplemented by radiography, which allows the differentiation between complete and incomplete dislocations. A complete dislocation can not be reduced by maneuvering bloodless injury is complex and requires surgical treatment. The reduction technique involves MCF hyperextension and replacement of the base of the phalanx. Other gestures should be avoided, and axial traction, risk of joint injury structures, cartilage growth or conversion of a simple dislocation into complex, to determine the need for surgical intervention. After reducing the stability of the collateral ligaments should be evaluated, often directly damaged by trauma or inappropriate gestures reducing the reduction of multiple attempts. Lateral instability may benefit from surgical correction. References STENER, B.: “Displacement of the ruptured ulnar collateral ligament of the metacarpo-phalangeal joint of the thumb”. A clinical and anatomical study. J. Bone Jt. Surg. 44-B: 869, 1962. STENER, B.: “Hyperextension injuries to the metacarpophalangeal joint of the thumb. Rupture of ligaments, fracture of sesamoid bones, rupture of flexor pollicis brevis. An anatomical and clinic study”. Acta Chir. Scand. 125: 275, 1963. COONRAD, R.W., GOLDNER, J.L.: “A study of the pathological findings and treatment in soft-tissue injury of the thumb metacarpophalangeal joint”. J. Bone Jt Surg. 59- A: 439, 1968. PARIKH, M., NAHIGIAN, S., FROIMSON, A.: “Gamekeeper’s thumb”. Plast. Reconstr, Surg. 58:24, 1976. STENER, B.: “Entorses récents de la métacarpophalangienne du pource”, en Traité de chirurgie de la main de Tubiana R. Tomo II, pág. 779. París, Masson, 1984. KAPLAN, E.B.: “The pathology and treatment of radial subluxation of the thumb with ulnar displacement of the head of the first metacarpal”. J. Bone Jt Surg. 43-A: 541, 1961. YAMANAKA, K., YOSHIDA, K., INOVE, A., MIYAGI, T.: “Locking of the metacarpophalangeal joint of the thurnb”. J. Bone Jt Surg. 67-A: 782, 1985. NAVES, J., SALVADOR, A., PUIG, M.: “Traumatología del deporte”. Pág. 251. Salvat, Barcelona, 1986, SMITH, R.J.: “Post-traumatic instability of the metacarpophalangeal joint of the thumb”. J. bone Jt Surg. 59-A: 14-21, 1977. Kasuaki M. Dorsal dislocations of the second to fifth carpometacarpal joints: a case report. Hand Surg 2008; 13(2): 129-132. Laforgia R, Specchiulli F, Mariani A. Dorsal dislocation of the fifth carpometacarpal joint. Hand Surg Am 1990; 15: 463-465. Gangloff D, Mansat P, Gaston A, Apredoaei C, Rongières M. Carpometacarpal dislocation of the fifth finger: descriptive study of 31 cases. Chir Main 2007; 26(4-5): 206-213. Epub 2007 Jul 16. Eichhorn-Sens J, Katzer A, Meenen NM, Rueger JM. Carpometacarpal dislocation injuries. Handchir, Mikrochir, Plast Chir 2001; 33(3): 189. Yoshida R, Shah MA, Patterson RM, Buford WL Jr, Knighten J, Viegas SF. Anatomy and pathomechanics of ring and small finger carpometacarpal joint injuries. J Hand Surg Am 2003; 28(6): 1035-1043.


2013 ◽  
Vol 40 (1) ◽  
pp. 68-75 ◽  
Author(s):  
G. Xiong ◽  
Y. Gao ◽  
S. Guo ◽  
L. Dai ◽  
K. Liu

Ten patients with metacarpophalangeal joint locking of the thumb were studied. Three of them underwent surgical release. During surgery, it was found that the radial sesamoid was seated in a cartilage defect on the volar aspect of the metacarpal head. It appeared that the defect was created by the proximal edge of sesamoid. When the abductor pollicis brevis and flexor pollicis brevis muscles were partially detached from their insertion at the base of the proximal phalanx, the locking could be successfully released. We hypothesize the mechanism of the metacarpophalangeal joint locking of the thumb in our cases was a hyperextension injury that displaced the radial sesamoid distally and radially. In turn, the sesamoid’s pointed proximal edge wore a groove in the cartilage on the metacarpal head, and under abductor pollicis brevis and flexor pollicis brevis tension, the radial sesamoid was locked into the cartilage defect; thereby causing locking of the joint.


2017 ◽  
Vol 22 (01) ◽  
pp. 35-38 ◽  
Author(s):  
Eichi Itadera ◽  
Takahiro Yamazaki

We developed a new internal fixation method for extra-articular fractures at the base of the proximal phalanx using a headless compression screw to achieve rigid fracture fixation through a relatively easy technique. With the metacarpophalangeal joint of the involved finger flexed, a smooth guide-pin is inserted into the intramedullary canal of the proximal phalanx through the metacarpal head and metacarpophalangeal joint. Insertion tunnels are made over the guide-pin using a cannulated drill. Then, a headless cannulated screw is placed into the proximal phalanx. All of five fractures treated by this procedure obtained satisfactory results.


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