Abstract
Introduction
Thumb metacarpophalangeal joint instability can have a considerable functional impairment. Acute injuries are usually overlooked in children due to the high pain threshold and the presence of ligamentous laxity. Chronicity of the injury results in failure of conservative treatment. Literature is poor in defining such injuries. The purpose of our study is to determine the clinical and radiological tools for the diagnosis of metacarpophalangeal joint instability and we propose a simple surgical technique for their management.
Methods
From 2015 till 2019, we present a case series of four patients with chronic post-traumatic thumb metacarpophalangeal joint instability. Patients were assessed for palmar plate avulsion clinically and radiologically using plain X-ray and sonography. Surgical repair through a palmar approach with direct repair of the palmar plate was done in all patients. Patient demographics, complications, and clinical outcomes were recorded.
Results
Mean follow-up was 22.5 months. At the latest follow-up the metacarpophalangeal joint was stable in all patients. They were all pain free except one patient suffered from temporary pain at the dorsum of the metacarpal due to prominence of the suture anchor, which disappeared at 1-year follow-up. They had improvement in pinch strength. Full range of motion was obtained and all the patients have returned to full activity without limitations.
Conclusion
Chronic post-traumatic thumb metacarpophalangeal joint instability results in functional impairment. Clinical suspicion and sonographic assessment can verify the diagnosis. Surgical repair with transosseous sutures or anchors yields satisfactory results in the paediatric age group with the preservation of normal range of motion.
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References
Cornwall R (2010) The painful wrist in the pediatric athlete. J Pediatr Orthop. https://doi.org/10.1097/bpo.0b013e3181d131f9
Langer MF, Oeckenpöhler S, Spies CK, Grünert JG, Breiter S, Glasbrenner J, Wieskötter B (2020) Dorsal plate arthrodesis of the thumb metacarpophalangeal joint. Oper Orthop Traumatol 32(1):47–57. https://doi.org/10.1007/s00064-019-0592-x
Schuurman AH, Bos KE (1993) Treatment of volar instability of the metacarpophalangeal joint of the thumb by volar capsulodesis. J Hand Surg Br 18:346–349. https://doi.org/10.1016/0266-7681(93)90060-s
Nikkhah D, Rodrigues J, Dejager L (2012) Managing thumb volar plate attenuation in children: a systematic review and case series. Hand Surg 17:117–120. https://doi.org/10.1142/s0218810412720100
Kapandji A (1986) Clinical test of apposition and counter-apposition of the thumb. Ann Chir Main 5:67–73. https://doi.org/10.1016/s0753-9053(86)80053-9
Stener B (1963) Hyperextension injuries of the metacarpophalangeal joint of the thumb rupture of ligaments, fracture of sesamoid bones, rupture of flexor pollicis brevis: an anatomical and clinical study. Acta Chir Scand 125:275–293
Kaplan EB (1984) Functional and surgical anatomy of the hand, 3rd edn. J. B. Lippincott, Philadelphia
Filler B, Stark H, Boyes J (1976) Capsulodesis of the metacarpophalangeal joint of the thumb in children with cerebral palsy. J Bone Joint Surg Am. 58:667–670. https://doi.org/10.2106/00004623-197658050-00015
Kessler I (1979) A simplified technique to correct hyperextension deformity of the metacarpophalangeal joint of the thumb. J Bone Joint Surg 61:903–905
Wong YC (2019) PC Ho (2019) Arthroscopic thermal shrinkage: a novel method for the treatment of chronic volar plate instability at the metacarpal phalangeal joint of the thumb. J Hand Surg Asian-Pac 24(3):347–352. https://doi.org/10.1142/S2424835519500449
Eiken O (1981) Palmaris Longus-Tenodesis for hyperextension of the thumb metacarpophalangeal Joint. Scand J Plastic Reconstr Surg 15:149–152. https://doi.org/10.3109/02844318109103427
Ishizuki M, Nakagawa T, Ito S (1994) Hyperextension injuries of the MP joint of the thumb. Hand Surg 19:361–367. https://doi.org/10.1016/0266-7681(94)90090-6
Jones DM, Jebson PJ, Blair WF (1996) Chronic post-traumatic hyperextension instability of the thumb metacarpophalangeal joint: results of the volar capsulodesis procedure. Iowa Orthop J 16:122–125
Lee YS, Seo BH, Oh U (2013) Posttraumatic chronic volar instability of the thumb metacarpophalangeal joint. J Korean Soc Surg Hand 18:67. https://doi.org/10.12790/jkssh.2013.18.2.67
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Aly, A.M., Nabil, A.M. Thumb metacarpophalangeal joint palmar plate chronic avulsion in children: diagnosis and treatment. Arch Orthop Trauma Surg 141, 1419–1423 (2021). https://doi.org/10.1007/s00402-021-03770-x
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DOI: https://doi.org/10.1007/s00402-021-03770-x