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CASE REPORT

Ulnar Collateral Ligament Injury Of The Thumb In The Skeletally Immature- An Easy Injury To Miss

*Gopalan S A, **Dias R, +Chugh S

**Upper Limb and Hand Fellow, Derbyshire Royal Infirmary, Derby, U.K
+Consultant Orthopaedic Surgeon, New Cross Hospital, Wolverhampton, U.K

Address for Correspondence
S A Gopalan
20 Doulton Drive, Smethwick, Birmingham
B66 1RA, UK
Phone: 01215581557
Email:sureshag@doctors.org.uk

Abstract

Ulnar collateral ligament injuries of the thumb are extremely rare in children. If not detected and repaired, it can lead to long-term instability of the metacarpophalangeal joint (Smith, 1977). We report an injury with a resultant tear of the ulnar collateral ligament in an 11-year-old boy after minor trauma.

J.Orthopaedics 2006;3(4)e25

Introduction:

Ulnar collateral ligament injury of the thumb is well recognised in adults (Campbell, 1955). However it is a rare injury in children with no cases reported before 1993 (Wallace & Carr). It is important to have a high index of suspicion where the mechanism of injury is one of excessive abduction force on the paediatric thumb, especially in the absence of any bony injury.

Case Report

An 11-year old boy presented to the A & E department following a fall from his bed. Inspite of the absence of any bony injury, his discomfort and a history of his thumb being ‘pushed over’ led to stress views being done. These showed gross ulnar-sided instability at the metacarpophalangeal joint of the thumb and a diagnosis of ulnar collateral ligament injury was made.

The patient underwent an exploration of the thumb the next day and a rupture of the ulnar collateral ligament with a Stener lesion (Stener, 1962) was identified. The ligament was primarily repaired by anchoring it to the thickened periosteum and the thumb was immobilised in plaster for 3/52. Four months later examination revealed normal function with a stable MCP joint.

Fig 1: Initial radiograph after injury showing a normal appearance

 

 

Fig 2:Stress radiograph of the thumb showing an injury to the ulnar collateral ligament

 

Discussion :

Ulnar collateral ligament injuries in the paediatric population is a rare condition and can be easily missed due to the minor discomfort exhibited by this group of patients and the low diagnostic rate on standard plain radiographs of the thumb. Clinicians tend to scan radiographs for an epiphyseal fracture and in its absence tend to label the injury as a ‘strain’ or ‘sprain’ of the thumb.

If the mechanism of injury is suggestive then a thorough examination should be carried out with stress views of the thumb under local anaesthesia and in some cases an examination under a general anaesthetic may be necessary. If missed these injuries can lead to long-term instability of the metacarpophalangeal joint of the thumb.

We emphasise the importance of having a high index of suspicion to diagnose these injuries since they are amenable to repair with good results (Derkash, 1987) in this age group.

Reference :

  1. Smith. RJ (1977). Post traumatic instability of metacarpophalangeal joint of the thumb. Journal of Bone and Joint Surgery, 59A: 1;14-21.

  2. Campbell CS (1955). Gamekeeper`s thumb. Journal of Bone and Joint Surgery, 37B: 148-149.

  3. Wallace DA, Carr AJ (1993). Rupture of the Ulnar Collateral Ligament of the thumb in a 5- year old girl. Journal of Hand Surgery, 18B: 501.

  4. Stener B. (1962). Displacement of the ruptured ulnar collateral ligament of the metacarpophalangeal joint of the thumb: A clinical and anatomical study. Journal of Bone and Joint Surgery, 44B: 4; 869-879.

  5. Derkash RS, Matyas JR, Weaver JK et al. (1987). Acute surgical repair of the skier’s thumb. Clinical Orthopaedics and Related Research, 216; 29- 33. 

 

This is a peer reviewed paper 

Please cite as : Gopalan S A: Ulnar Collateral Ligament Injury Of The Thumb In The Skeletally Immature- An Easy Injury To Miss

J.Orthopaedics 2006;3(4)e25

URL: http://www.jortho.org/2006/3/4/e
25

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