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Meyer Zu Reckendorf G, Artuso M, Kientzi M, Rouzaud JC. Collateral ligament sprains of the metacarpophalangeal joint of the long fingers: Results of a surgical series of 15 patients. Orthop Traumatol Surg Res 2023; 109:102952. [PMID: 33951542 DOI: 10.1016/j.otsr.2021.102952] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 01/16/2021] [Accepted: 01/26/2021] [Indexed: 02/03/2023]
Abstract
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.
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Affiliation(s)
- Gero Meyer Zu Reckendorf
- Institut Montpelliérain de la main et du membre supérieur, clinique Saint-Roch, 560, avenue du Colonel Pavelet, 34070 Montpellier, France
| | - Mickaël Artuso
- Institut Montpelliérain de la main et du membre supérieur, clinique Saint-Roch, 560, avenue du Colonel Pavelet, 34070 Montpellier, France.
| | - Mylène Kientzi
- Institut Montpelliérain de la main et du membre supérieur, clinique Saint-Roch, 560, avenue du Colonel Pavelet, 34070 Montpellier, France
| | - Jean-Claude Rouzaud
- Institut Montpelliérain de la main et du membre supérieur, clinique Saint-Roch, 560, avenue du Colonel Pavelet, 34070 Montpellier, France
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Kudo S, Aoyagi T, Kobayashi T, Koshino Y, Edama M. Ultrasound Imaging of Subtalar Joint Instability for Chronic Ankle Instability. Healthcare (Basel) 2023; 11:2227. [PMID: 37570468 PMCID: PMC10418656 DOI: 10.3390/healthcare11152227] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/03/2023] [Accepted: 08/04/2023] [Indexed: 08/13/2023] Open
Abstract
The purpose of this study was to develop the assessment of subtalar joint instability with chronic ankle instability (CAI) using ultrasonography. Forty-six patients with anterior talofibular ligament (ATFL) abnormalities and a history of ankle sprain were divided into CAI (21.2 ± 5.9 y/o, 7 males and 17 females) and asymptomatic groups (21.0 ± 7.4 y/o, 9 males and 12 females) on the basis of subjective ankle instability assessed using the CAIT and the Ankle Instability Instrument Tool (AIIT). Twenty-six age-matched feet participated in a control group (18.9 ± 7.0 y/o, 9 males and 17 females). Ultrasound measurements of the width of the posterior subtalar joint facet were obtained at rest and maximum ankle inversion (subtalar joint excursion; STJE). The differences in STJE among the three groups were assessed by one-way ANOVA. The relationship between STJE and subjective ankle instability was assessed using Spearman's correlation tests. The STJE value was significantly greater in the CAI group (2.3 ± 0.8 mm) than in the asymptomatic (1.0 ±0.4 mm) and control groups (0.8 ±0.2 mm) (p < 0.001, effect size: 0.64). STJE had significant negative correlations with CAIT (r = -0.71, p < 0.01), and significant positive correlations with AIIT (r = 0.74, p < 0.01). The cut-off value to distinguish between the CAI and asymptomatic groups was 1.7 mm using the ROC curve.
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Affiliation(s)
- Shintarou Kudo
- Department of Physical Therapy, Morinomiya University of Medical Sciences, Osaka 559-8611, Japan;
| | - Tsutomu Aoyagi
- Department of Physical Therapy, Morinomiya University of Medical Sciences, Osaka 559-8611, Japan;
- Department of the Rehabilitation, Oyamadai Orthopedics Clinic Tokyo Arthroscopy Center, Tokyo 158-0082, Japan
| | - Takumi Kobayashi
- Department of Rehabilitation, Hokkaido Chitose College of Rehabilitation, Chitose 066-0055, Japan;
| | - Yuta Koshino
- Faculty of Health Sciences, Hokkaido University, Sapporo 060-0812, Japan;
| | - Mutsuaki Edama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata 950-3102, Japan;
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Langdell HC, Zhang GX, Pidgeon TS, Ruch DS, Klifto CS, Mithani SK. Management of Complex Hand and Wrist Ligament Injuries. Hand Clin 2023; 39:367-377. [PMID: 37453764 DOI: 10.1016/j.hcl.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Ligamentous injuries in the hand and wrist are often underdiagnosed and can present with significant functional limitations if there is untimely recognition of injury. Adequate repair or reconstruction is critical in restoring joint stability and mobility. The purpose of this review is to provide an overview of the metacarpophalangeal joint, scapholunate interosseous ligament (SLIL), and non-SLIL carpal ligament anatomy, diagnosis, imaging, treatment consideration and options, as well as surgical techniques encompassing repair, reconstruction, and fusion.
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Affiliation(s)
- Hannah C Langdell
- Division of Plastic and Reconstructive Surgery, Duke University Medical Center, Durham, NC, USA
| | - Gloria X Zhang
- Department of Orthopedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Tyler S Pidgeon
- Department of Orthopedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - David S Ruch
- Division of Plastic and Reconstructive Surgery, Duke University Medical Center, Durham, NC, USA
| | - Christopher S Klifto
- Department of Orthopedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Suhail K Mithani
- Division of Plastic and Reconstructive Surgery, Duke University Medical Center, Durham, NC, USA; Department of Orthopedic Surgery, Duke University Medical Center, Durham, NC, USA.
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Chen PH, Chen CY. Rupture of finger distal interphalangeal collateral ligament treated with a mini soft anchor. Injury 2023:S0020-1383(23)00250-4. [PMID: 36977618 DOI: 10.1016/j.injury.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/03/2023] [Accepted: 03/06/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Ruptured finger distal interphalangeal (DIP) collateral ligament is a rare injury, with controversial treatment until the present. Our case series aimed to demonstrate feasible surgical intervention using a mini anchor. METHODS The present study includes four patients with ruptured finger DIP collateral ligaments who received primary repair in a single institute. They have suffered from joint instability due to ligament loss caused by infection, motorcycle accidents, and work-related accidents. All patients were operated on similarly using a 1.0 mm mini anchor for ligament reattachment. RESULTS The finger DIP joint range of motion (ROM) was documented in all patients during follow-up. Joint ROM recovered to almost normal degrees, and the pinch strength recovered to > 90% compared to the contralateral side in all patients. Additionally, collateral ligament re-rupture, DIP joint subluxation or re-dislocation, and infection were not noted during follow-up. CONCLUSIONS Ruptured finger DIP joint ligament requiring surgery is usually based on a combination with other soft tissue injuries and defects. However, repair with a 1.0 mm mini anchor is a feasible surgical intervention to reattach the ligament with minimal complication.
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Affiliation(s)
- Po-Hsiang Chen
- Department of Orthopaedics, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Road, Extn: 3051, Kaohsiung city, Taiwan, ROC; Department of Medical education and research, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Road, Kaohsiung city, Taiwan, ROC
| | - Chun-Yu Chen
- Department of Orthopaedics, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Road, Extn: 3051, Kaohsiung city, Taiwan, ROC; Department of Occupational Therapy, Shu-Zen Junior College of Medicine and Management, Kaohsiung city, Taiwan, ROC; Department of Biomedical Engineering, I-Shou University, Kaohsiung city, Taiwan, ROC.
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Jiang EX, Korn MA, King EA, van Holsbeeck M. Entrapment of the index finger radial collateral ligament in the metacarpophalangeal joint: A case report. ULTRASOUND (LEEDS, ENGLAND) 2022; 30:323-327. [PMID: 36969541 PMCID: PMC10034649 DOI: 10.1177/1742271x211055844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 10/04/2021] [Indexed: 11/16/2022]
Abstract
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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Affiliation(s)
- Eric X Jiang
- Department of Orthopedic Surgery, Henry Ford Hospital, Detroit, MI,
USA
| | - Michael A Korn
- Department of Orthopedic Surgery, Henry Ford Hospital, Detroit, MI,
USA
| | - Elizabeth A King
- Department of Orthopedic Surgery, Henry Ford Hospital, Detroit, MI,
USA
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Sahin MS. The Accuracy and Cost-Effectiveness of MRI Assessment of Collateral Ligament Injuries of the Lesser Digits’ Proximal Interphalangeal Joints. Cureus 2022; 14:e28306. [PMID: 36158352 PMCID: PMC9498160 DOI: 10.7759/cureus.28306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2022] [Indexed: 11/27/2022] Open
Abstract
Background Collateral ligament injuries of the thumb and lesser digits are simple injuries, but they may lead to disabilities in hand function. This study aimed to evaluate the accuracy and cost-effectiveness of magnetic resonance imaging (MRI) in diagnosing proximal interphalangeal (PIP) collateral ligament injuries of lesser digits. Methods A retrospective evaluation was conducted on 18 fingers that had undergone surgery for PIP joint complete collateral ligament injury. Pre-operative MRI results were compared with the intra-operative findings. The data from MRI and direct intraoperative findings were analyzed by the Chi-square test in paired groups. The McNemar test analyzed the accuracy of the MRI test for detecting volar plate injuries. Statistical Packages for Social Sciences (SPSS) version 25 (IBM Inc., Armonk, New York) software program was used for the analysis. Results In digits other than the thumb, the accuracy of MRI for detecting collateral injuries was 38.89%, and detection was incorrect in 11 (61.11%) of 18 patients. There are significant differences between MRI and Intraoperative results (p<0.001). MRI findings for seven fingers (38.89%) of the 18 fingers involved were compatible with the surgery results (38.88%). By comparison, the MRI findings of 11 fingers (61.11%) were inconsistent with the intra-operative results. Eight patients (44.44%) were diagnosed preoperatively with MRI as having volar plate ruptures, three patients (16.67%) were diagnosed with open surgery, but only three of the volar plate diagnosed patients with MRI were verified as ruptures during open surgery (38.0%). In addition, preoperatively undetected volar plate injuries by MRI (n=10) were detected intra-operatively in three cases (30.0%). Therefore, the accuracy of MRI was found not to be statistically significant for the detection of volar plate injuries (p=0.727). Conclusion This study concluded that a 1.5-Tesla MRI with a slice thickness of 2-3 mm should not be relied on as a decisive tool for diagnosing collateral ligament injuries of the PIP joint of the lesser digits. Additionally, MRI was found insufficient for diagnosing volar plate injuries that accompanied collateral ligament injuries. Given these findings, one might conclude that MRI is not cost-effective in diagnosing collateral ligament injuries of the lesser digits PIP joint.
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Validation of the spontaneous lateral laxity sign for radial collateral ligament sprain of the metacarpophalangeal joint of the fingers: Anatomical study. HAND SURGERY & REHABILITATION 2022; 41:347-352. [DOI: 10.1016/j.hansur.2022.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/18/2022] [Accepted: 01/22/2022] [Indexed: 11/20/2022]
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Silva FBD, Giostri GS. Traumatized Hand - Update at the First Visit. Rev Bras Ortop 2021; 56:543-549. [PMID: 34733424 PMCID: PMC8558942 DOI: 10.1055/s-0041-1735173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 06/15/2021] [Indexed: 11/21/2022] Open
Abstract
The hand is the segment most exposed to trauma, with a large volume of care in urgent and emergency services. Therefore, it is necessary that physicians on duty have the essential knowledge to effectively manage these injuries. In the present article, we will review the main conditions and conduct guidelines.
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Affiliation(s)
| | - Giana Silveira Giostri
- Professora Adjunta da Escola de Medicina, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brasil
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Index Finger Metacarpophalangeal Joint Arthrodesis With a Dorsal Locking Plate. Tech Hand Up Extrem Surg 2019; 24:47-52. [PMID: 31693572 DOI: 10.1097/bth.0000000000000270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Index finger metacarpophalangeal (MCP) joint arthrodesis is a potential reconstructive option for recalcitrant MCP arthritis. Due to lateral forces applied by the thumb, our institutional experience supports index finger MCP arthrodesis as a successful option in younger, higher demand patients and in the setting of significant joint instability. We present our technique of performing index finger MCP arthrodesis using a dorsal locking plate. The proposed benefits of this technique include the ability to position the MCP joint in the desired degree of flexion, generation of parallel fusion surfaces with even compression across the arthrodesis site, and stable fixation.
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Surgical Fixation of Metacarpophalangeal Collateral Ligament Rupture of the Fingers. Plast Reconstr Surg 2019; 143:1421-1428. [DOI: 10.1097/prs.0000000000005575] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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