Mini Hook Plate Fixation for the Thumb Ulnar Collateral Ligament Fracture-Avulsion

Sang-yun Lee; Sang Hyun Woo; Ho-Jung Kang

doi:10.12790/ahm.2019.24.2.142

Journal List > Arch Hand Microsurg > v.24(2) > 1125368

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Lee, Woo, and Kang: Mini Hook Plate Fixation for the Thumb Ulnar Collateral Ligament Fracture-Avulsion

Original Article

Arch Hand Microsurg 2019;24(2):142-151.

Published online: 5 January 2019

DOI: https://doi.org/10.12790/ahm.2019.24.2.142

Mini Hook Plate Fixation for the Thumb Ulnar Collateral Ligament Fracture-Avulsion

Sang-yun Lee¹, Sang Hyun Woo¹, Ho-Jung Kang²

¹W Institute for Hand and Reconstructive Microsurgery, W General Hospital, Daegu, Korea

²Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea

Corresponding author: Ho-Jung Kang Department of Orthopedic Surgery, Gangnam Severance Hospital, 211 Eonju-ro, Gangnam-gu, Seoul 06273, Korea TEL: +82-2-2019-3412, FAX: +82-2-573-5393, E-mail: kangho56@yuhs.ac

Received 19 February 201928 April 2019 Accepted 1 May 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

초록

Purpose:

Ulnar collateral ligament (UCL) avulsion fractures of thumb metacarpophalangeal joint (MCPJ) involve small bony fragments that are usually attached to structures that are necessary for stability or movement of the joint. Satisfac-tory reduction can be difficult because of the small size of the fragments. The aim of this article is to analyze outcomes of this technique.

Methods:

We used a 1.2 mm titanium hook plate in seven patients with thumb UCL avulsion fracture of MCPJ, with a mean age of 33 years. The mean time from injury to operation was 13 days. Bone union was determined through radiographs. Clinical outcomes were evaluated by assessing range of motion (ROM) of the thumb MCPJ, pinch strength, grip strength, the visual analogue scale (VAS), and Korean version of the Michigan Hand Outcomes Questionnaire (K-MHQ) score.

Results:

All patients achieved bone union within 3 months and mean follow-up period was 14.3 months. The postoperative ROM and VAS pain score improved. Grip and pinch strength were lower than the other hand but not statistically significant. No instability was observed. In addition, postoperative K-MHQ scores showed good results. One patient un-derwent hardware removal because of skin irritation and abnormal sensation. There were no other complications.

Conclusion:

Mini hook plate fixation technique produced stable fixation and showed good clinical and radiologic outcomes in avulsion fracture of thumb MCPJ.

Keywords: Thumb, Ulnar collateral ligament, Avulsion fractures, Hook plate fixation

REFERENCES

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Fig. 1.

The Medartis APTUS^® 1.2-mm titanium hand plate and screws.

Fig. 2.

Mini hook plate holder.

Fig. 3.

A 35-year-old female sustained an outstretched injury of the left thumb metacarpophalangeal joint. (A, B) A preoperative plain radiographs showed displaced 1st proximal phalanx base fracture (white arrows). (C) Ulnar collateral ligament (UCL) avulsion fracture with Stener lesion was observed on the 1st metacarpophalangeal joint on magnetic resonance imaging (white arrowhead). (D, E) The UCL avulsion fragment was located above the adductor aponeurosis (black asterisk). After capsule opening, the bone fragment was reduced via hook plate fixation. The surrounding soft tissues were well repaired. (F-H) Postoperative images showed stable fixation of the bone fragment. (I) At 3 months postoperatively, X-ray was well maintained and recovered to full range of motion without pain.

Fig. 4.

A 42-year-old male sustained an outstretched injury of the left thumb metacarpophalangeal joint. (A, B) A preoperative plain radiographs showed displaced 1st proximal phalanx base fracture (white arrows). (C) Ulnar collateral ligament (UCL) avulsion fracture and UCL injury from metacarpal head was observed on the 1st metacarpophalangeal joint on magnetic resonance imaging (white arrowhead). (D, E) Bone fragment (black asterisk) was reduced via hook plate fixation. UCL rupture was repaired with one suture anchor. After all procedures, surrounding soft tissues were well repaired (black arrows). (F-I) Postoperative images showed stable fixation of the bone fragment. (J) At 6 months postoperatively, X-ray was well maintained and recovered to full range of motion without pain.

Fig. 5.

Use of hook plate for radial collateral ligament avulsion fracture of thumb metacarpophalangeal joint (arrows).

Table 1.

Summary of cases

Case No.	Sex	Age (yr)	Side	Mechanism of injury	Period from injury to date of operation (d)	Follow-up duration (mo)	Time to bone union (mo)	Flexion range of motion (°)		Extension range of motion (°)		Etc.
Case No.	Sex	Age (yr)	Side	Mechanism of injury	Period from injury to date of operation (d)	Follow-up duration (mo)	Time to bone union (mo)	Preoperative	Postoperative	Preoperative	Postoperative	Etc.
1	F	41	L	Outstretched thumb injury	4	15	3	35	50	0	–5	Hardware irritation → removal at 8 months after surgery
2	F	35	L	Outstretched thumb injury	10	14	2	15	55	–10	5	Stener lesion
3	M	42	L	Outstretched thumb injury	20	16	3	40	45	0	–5	MCPJ UCL partial rupture → ligament augmentation using suture anchor
4	M	19	R	Direct contact	52	12	2	50	55	10	0	-
5	M	43	L	Outstretched thumb injury	2	16	3	15	40	0	–5	Volar plate injury
6	M	33	R	Outstretched thumb injury	1	14	3	30	50	0	–5	-
7	F	21	L	Outstretched thumb injury	2	13	2.5	30	55	0	5	Volar plate injury

F: female, L: left, M: male, MCPJ: metacarpophalangeal joint, UCL: ulnar collateral ligament, R: right.

Table 2.

Clinical outcomes at last follow-up

Variable	Preoperative	Postoperative	p-value∗
Range of motion (°)
Flexion	30.7	50.0	0.018†
Extension	0.0	–1.4	0.483
Radial abduction	14.3	25.7	0.017†
Grip strength (%)‡	-	87.4	0.128
Pinch strength (%)‡	-	88.2	0.128
Visual analogue scale pain	8.1	2.3	0.017†

Values are presented as mean only.

^∗ The p-values are assessed by two-sample t-test, Welch two-sample test or Wilcoxon rank sum test in continuous values, and by Fisher test in categorical values.

^† p<0.05.

^‡ Percentage compared to contra-lateral side.

Table 3.

Six months postoperative K-MHQ scores

Scale	Postoperative	Raw score range∗	Normalization†
Function	75.7	5 to 25	–(Raw score–25)/20×100
ADL	93.3	5 to 25 1-handed	–(Raw score–25)/20×100
		7 to 35 2-handed	–(Raw score–35)/28×100
		Overall ADL	=(1-handed+2-handed)/2
Work	85.3	5 to 25	(Raw score–5)/20×100
Pain	12.9	5 to 25	–(Raw score–25)/20×100
Aesthetics	75.0	4 to 16	(Raw score–4)/16×100
Satisfaction	81.6	6 to 30	–(Raw score–30)/24×100

Values are presented as mean only.

K-MHQ: Korean version of the Michigan Hand Outcomes Questionnaire, ADL: activities of daily living.

^∗ Sum of the responses for each scale.

^† All of the K-MHQ scales are based on a score from 0 to 100. For all of the scales except pain, a higher score translates into better performance for the patient's hand. For the pain scale, the relationship is inverse: the lower the score, the less pain the patient experiences, which signifies a better outcome.

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