Article
Complex thumb metacarpophalangeal joint dislocation caused by ulnar collateral ligament entrapment in a 6-year-old
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Published: | February 6, 2020 |
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Objectives/Interrogation: Case Report
Methods: A right handed 6-year-old girl presented to the hand trauma clinic with a painful left thumb having fallen on it whilst playing 11 days previously. On examination, her thumb was tender and dorsally angulated at the level of the MCPJ. There was minimal active movement at the joint. Examination and stress manipulation of the joint was not performed given the child's age and discomfort. An xray showed a dorso-radial dislocation at the thumb MCPJ. Under general anesthetic, a further attempt at closed reduction proved futile. Open surgical exploration by a dorsal approach of the metacarpophalangeal joint revealed avulsion of the proximal origin of the ulnar collateral ligament with a slip of periosteum. This was identified within the joint space and tethered by fibrous tissue. There was no damage to the radial collateral ligament or volar plate. The avulsion was mobilised and a successful reduction was achieved. The ligament was re-attached to its anatomical position on the metacarpal head using a transosseous suture.
Results and Conclusions: In irreducible thumb metocarpophalangeal (MCPJ) dislocations, the volar plate is most commonly found in the joint preventing closed reduction. We present a 6 year old child with an irreducible thumb MCPJ, of which we identified the ulnar collateral ligament as the culprit interposing soft tissue stopping reduction. This has not been described before and we wish to share our clinical and surgical management of this unique case.