First interosseous-plasty: a technique to reconstruct the radial collateral ligament of the MCP-joint of the index finger

A 21 year-old woman with achondroplasia exhibited locking of the metacarpophalangeal joint of the right index finger which required surgery to release the joint. Locking was confirmed to be due to entrapment of the fan-like part of the radial collateral ligament on a metacarpal head prominence arising from epiphysial thickening.

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Entrapment of the index finger radial collateral ligament in the metacarpophalangeal joint: A case report

Ultrasound ◽

10.1177/1742271x211055844 ◽

2021 ◽

pp. 1742271X2110558

Author(s):

Eric X Jiang ◽

Michael A Korn ◽

Elizabeth A King ◽

Marnix van Holsbeeck

Keyword(s):

Case Report ◽

Index Finger ◽

Metacarpophalangeal Joint ◽

Injury Pattern ◽

Acute Injury ◽

Ligament Injury ◽

Collateral Ligament ◽

Radial Collateral Ligament ◽

Superb Microvascular Imaging ◽

Microvascular Imaging

Introduction Digital collateral ligament injuries are common hand injuries that can cause significant pain and functional impairment. Ultrasonography can be useful in the evaluation of these ligamentous injuries, as it is both cost-effective and allows for easy, dynamic evaluation during imaging. Case report We report a rare sonographic finding of an index finger radial collateral ligament injury that was found to have a flap of the ligament entrapped within the metacarpophalangeal joint, which to our knowledge has not been described previously. We correlate this finding with an intraoperative image of the entrapment of the collateral ligament. We also report on the novel application of superb microvascular imaging to aid in the diagnosis of digital collateral ligament injury. Discussion This particular injury pattern has not been reported in the literature previously and likely explains the patient’s lack of improvement with nonoperative management. Our finding is similar to a Stener lesion seen in a thumb ulnar collateral ligament injury in which the ligament is unable to heal due to entrapment. In addition, using superb microvascular imaging (SMI), we were able to visualize hyperemia to surrounding structures and the ligament itself which suggested an acute injury. Conclusion We anticipate that this case report will provide sonographers with knowledge and images of this specific injury pattern to the digital collateral ligaments.

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Rupture of the Radial Collateral Ligament of the Metacarpo-Phalangeal Joint of the Index Finger: A Report of Three Cases

Journal of Hand Surgery (European Volume) ◽

10.1016/0266-7681_89_90140-x ◽

1989 ◽

Vol 14 (2) ◽

pp. 248-250

Author(s):

J. R. DOYLE ◽

R. E. ATKINSON

Keyword(s):

Operative Treatment ◽

Index Finger ◽

Collateral Ligament ◽

Radial Collateral Ligament ◽

Radial Side ◽

Complete Rupture ◽

Little Finger

We have diagnosed and treated three patients with complete rupture of the radial collateral ligament of the metacarpo-phalangeal joint of the index finger. Rupture of the radial collateral ligament of the metacarpo-phalangeal joint occurs most commonly in the little finger and has not previously been reported in the index finger. Operative treatment is recommended in all cases, due to the significant stresses placed on the radial side of the M.P. joint of the index finger.

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28-year-old woman training fencing with isolated rupture of radial collateral ligament of the metacarpophalangeal joint of the index finger

Sports Orthopaedics and Traumatology ◽

10.1016/j.orthtr.2015.06.009 ◽

2015 ◽

Vol 31 (3) ◽

pp. 228-232

Author(s):

Karolina Stępień ◽

Robert Śmigielski

Keyword(s):

Index Finger ◽

Metacarpophalangeal Joint ◽

Collateral Ligament ◽

Radial Collateral Ligament

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Results of tension band wiring in intra-articular collateral ligament avulsion fractures of the phalanx

Journal of Kathmandu Medical College ◽

10.3126/jkmc.v6i2.19807 ◽

2018 ◽

Vol 6 (2) ◽

pp. 74-77

Author(s):

Rajeev Raj Manandhar ◽

Shishir Lakhey ◽

Umash Karki

Keyword(s):

Functional Outcome ◽

Soft Tissues ◽

Proximal Phalanx ◽

Ring Finger ◽

Ulnar Collateral Ligament ◽

Tension Band ◽

Tension Band Wiring ◽

Collateral Ligament ◽

Avulsion Fractures ◽

Radial Collateral Ligament

Background: Avulsion fractures of the base of proximal phalanx associated with ulnar or radial collateral ligament instability are relatively rare. The small size of the fragment and strong deforming pull of the attached soft tissues make the process of reduction and maintenance difficult.Objective: The purpose of this study was to assess the functional outcome of tension band wiring in intra-articular avulsion fractures of the base of the proximal phalanx.Methodology: A prospective study was performed on ten patients with intra-articular collateral ligament avulsion fractures of the proximal phalanx (Jupiter’s classification Type III). A tension band construct was performed using a dorsal approach. The functional outcome was assessed at six months with the quick Disability of Arm, Shoulder and Hand score.Results: The mean age of the patients was 25.8 years (Mean ± SD: 25.80). Six avulsion fractures were of the ulnar collateral ligament of the proximal phalanx of the index finger, one involved the radial collateral ligament of the ring finger and three, the radial collateral ligament of the little finger suggesting an abduction injury. All fractures had united at three months. Eight patients were graded as excellent and two as good. All patients were satisfied with the surgery and the functional outcome of the injured digit. There were no perioperative complications.Conclusion: The functional outcome of tension band wiring in intra-articular collateral ligament avulsion fractures of the base of the proximal phalanx was good to excellent.

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ROTATORY SUBLUXATION OF THE METACARPOPHALANGEAL INDEX FINGER JOINT: A CASE REPORT

Hand Surgery ◽

10.1142/s0218810413720064 ◽

2013 ◽

Vol 18 (01) ◽

pp. 103-105 ◽

Cited By ~ 1

Author(s):

Ken Teo ◽

Anthony Berger

Keyword(s):

Case Report ◽

Index Finger ◽

Extensor Tendon ◽

Metacarpophalangeal Joint ◽

Clinical Suspicion ◽

Collateral Ligament ◽

Open Injury ◽

Complete Tear ◽

Rotatory Subluxation ◽

High Level

We report a case of rotatory subluxation of the metacarpophalangeal joint (MCPJ) of the finger. A 40-year-old man sustained an open injury to his index finger following an explosive injury. Radiographs showed rotatory subluxation of the index finger MCPJ. The index finger extensor digitorium was found interposed in the MCPJ, with a complete tear of the radial collateral ligament. Treatment was by open reduction and repair of the collateral ligament and the extensor tendon. A high level of clinical suspicion is needed to diagnose this entity.

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IRREDUCIBLE VOLAR SUBLUXATION OF THE PROXIMAL INTERPHALANGEAL JOINT DUE TO RADIAL COLLATERAL LIGAMENT INTERPOSITION: CASE REPORT AND REVIEW OF LITERATURE

Hand Surgery ◽

10.1142/s0218810415720053 ◽

2015 ◽

Vol 20 (01) ◽

pp. 153-157 ◽

Cited By ~ 5

Author(s):

Jason Pui Yin Cheung ◽

Wing Lim Tse ◽

Pak Cheong Ho

Keyword(s):

Joint Stiffness ◽

Extensor Tendon ◽

Proximal Interphalangeal Joint ◽

Careful Examination ◽

Preoperative Imaging ◽

Loss Of Function ◽

Flexion Deformity ◽

Collateral Ligament ◽

Radial Collateral Ligament ◽

Primary Assessment

Irreducible volar subluxation should be considered when assessing a patient with flexion deformity of the proximal interphalangeal finger joint (PIPJ). Primary assessment requires careful examination of the collateral ligaments and extensor tendon. Preoperative imaging such as ultrasound and MRI can help identify the interposed structures and plan the subsequent operation. Although rare, irreducible volar subluxation due to radial collateral ligament interposition is an important entity to be aware of. Prompt and appropriate management can prevent joint stiffness and loss of function.

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