Kollateralbandverletzungen der Fingergrundgelenke

Collateral ligament sprains of the metacarpophalangeal joint of the long fingers: Results of a surgical series of 15 patients

INTRODUCTION

Collateral ligament sprains of the metacarpophalangeal joint (MP) of the long fingers are rare and mostly treated conservatively. Clinical examination to diagnose the severity of these injuries is mandatory. The purpose of our study is to report the results of 15 patients treated surgically.

METHODS

Twenty-three patients, mean age 48, underwent surgery for Stage 3 radial collateral ligament (RCL) injuries of the middle finger (12), the ring finger (4) and the little finger (7). The mean time from trauma to surgery was 53 days. The clinical evaluation consisted of measuring active joint motion, performing laxity tests at 0°, 30° and 90° of MP flexion, testing for laxity and rotation, looking for a spontaneous overlapping finger (or hyperabducted little finger) in relaxed position and measuring the strength (Jamar).

RESULTS

Among the 23 operated patients, RCL lesions were distal in 8 cases, proximal in 9, and mid-substance in 6. There were 2 Stener-like lesions. Preoperatively, 16 patients presented an overlapping finger over the next one and 7 had spontaneous hyperabduction of the fifth finger. Mean follow-up of the 15 patients reviewed was 24 months (8-56). Mean MP flexion-extension range of motion was 86°/11° (71-99/0-29). Mean MP ulnar laxity of the injured finger was 18°, 14° and 11° respectively at 0°, 30° and 90° and 19°, 16°and 13°on comparison to the same digit on the opposite side. Mean MP radial laxity of the injured finger was 28°, 22° and 10° respectively at 0°, 30°, 90°, same digit on opposite side was 29°, 21°, 11°. There were no postoperative overlapped or hyperabducted fingers concerning spontaneous lateral laxity in extension. The postoperative rotational laxity test showed differences of arc in supination and pronation between operated finger and healthy side of respectively -12% and +8%.

CONCLUSION

The postoperative results of RCL repair of the MP in the long fingers are good in spite of some residual ligamentous distension, revealed by the laxity tests. The lateral laxity sign as a simple painless clinical sign for diagnosing complete RCL tears requiring surgery needs a validating study in order to spread its use.

LEVEL OF EVIDENCE

IV; retrospective study.

Complex lesion of the third metacarpophalangeal joint: complete tear of the radial collateral and deep transverse metacarpal ligament

Injuries of collateral ligaments of MCPs joints are often underdiagnosed but have to be considered serious traumas of the hand. In many cases they concern thumb and rarely long fingers. Closed rupture of the deep transverse metacarpal ligament (DTML) is an unusual parallel injury. Both lesions present similar symptoms included local pain, swelling, ecchymosis and deviation of the finger in flexion and can be misdiagnosed. We describe the treatment of a 34 years old woman who sustained a complex lesion of the soft tissues of third metacarpophalangeal joint with complete close tear of the radial collateral and deep transverse metacarpal ligament following a fall during a walk thus leading to a multiplanar instability. Surgery consisted in mini anchor repair or the collateral ligament tear, direct resorbable suture of DTML and a double k-wire stabilization. Follow up at 11 months has shown excellent functional outcomes.

[Metacarpophalangeal joint injuries and sequelae]

Injuries of the metacarpophalangeal joints of the thumb and fingers are of a bony or ligamentous nature. They can heal without subsequent problems if correctly diagnosed and treated but incorrect or absent diagnostics and therapy can result in chronic instability, dislocation, fusion as well as subsequent arthritis and functional limitations. They can lead to substantial impairment of the gripping function. Fractures with inclusion of joints and with fragments sufficiently large for refixation are as a rule treated operatively just as differences in torsion and instability. Persisting instabilities are secondarily stabilized by ligamentoplasty and arthritis of the metacarpophalangeal joint of the thumb is treated by fusion. For metacarpophalangeal joints of the fingers the main concern is preserving motion. Established salvage operations for arthritis include denervation, resection arthroplasty and systematic arthrolysis for impairment of the joint and contractures with intact joint surfaces. Even in chronic conditions, with appropriate treatment good functional results for metacarpophalangeal joints of the thumb and fingers can be achieved. This article presents the current pathophysiological principles and concepts for diagnostics and therapy of acute and chronic injuries of the metacarpophalangeal joints of fingers and thumbs.