gms | German Medical Science

14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

Collateral ligament injuries of the metacarpophalangeal joint in long fingers. Results of a series of 20 patients. Presentation of a new clinical test

Meeting Abstract

  • presenting/speaker Gero Meyer Zu Reckendorf - IMM, Clinique St Roch, Montpellier, France
  • Mylene Kientzi - IMM, Clinique St Roch, Montpellier, France
  • Jean Claude Rouzaud - IMM, Clinique St Roch, Montpellier, France

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-236

doi: 10.3205/19ifssh0549, urn:nbn:de:0183-19ifssh05495

Published: February 6, 2020

© 2020 Meyer Zu Reckendorf et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objectives/Interrogation: Collateral ligament injuries of the metacarpophalangeal (MP) joint in long fingers are rare conditions and mostly treated conservatively in comparison to the thumb. Clinical examination is essential to diagnose the gravity of the ligamenteous injury. The aim of our study was to report results of surgical management of a series of 20 patients and to focus on a new clinical test.

Methods: 20 patients, mean age 48 years (22-70), were managed surgically for grade 3 injuries of the radial collateral ligament (RCL) of the middle finger (9), ring (4) and small finger (7). The mean delay between accident and surgery was 59 days (0-180). Preoperatively the new laxity test (Meyer's test) was positive in all cases. Surgical intervention found 2 Stener lesions.

Postoperatively the MP joint was protected by an extension orthoses for one month, following by a syndactyly for two months. Patients were reviewed by an independent examiner with a mean follow of 20 months (6-34). Total active motion (TAM) was measured, comparative MP laxity tests were performed at 0°, 30° and 90° of flexion, the Meyer and Bellemere tests were compared to the normal hand and strength measurements were realized.

Results and Conclusions: 15 patients were reviewed for clinical examination. One complication was noted (CRPS type 1). Mean Quick Dash was 16.2 (0-61). Mean TAM was 251° (218-308°) with mean active MP flexion-extension of 86-11° (72-99°/0-29°). The mean radial MP laxity at 0°, 30° and 90° of the injured digit was respectively of 22°, 15° and 13° compared to the normal side 18°, 17° and 14°. The mean ulnar MP laxity at 0°, 30° and 90° of the injured digit was respectively of 30°, 25° and 12° compared to the normal side 31°, 22° and 12°. Meyer's test shows a mean MP laxity of 17° (7-34°) of the injured digit and 13° (9-16°) on the normal side. Bellemere's test to radial and ulnar side on the injured digit shows a mean MP laxity of 12° and 11° compared to 24° and 10° on the normal hand. The mean global strength (Jamar) of the operated hand was 29 kg and 35 kg on the opposite side. Distal and lateral pinch measurements on the injured digit revealed a mean strength of 7 kg and 3 kg compared to 9 kg and 3 kg on the normal side.

Clinical results after RCL repair on the MP joint of long fingers are good despite some residual ligament distension demonstrated by our laxity tests measurements. Our new laxity test is a simple and painless clinical test allowing to diagnose grade 3 RCL injuries necessitating surgical repair.