Department of Orthopaedic Surgery, Université Libre de Bruxelles, Brussels, Belgium.
Hand and Microsurgery Unit, Division of Orthopaedic Surgery, Ain Shams University, Hospital, Cairo, Egypt.
Arch Orthop Trauma Surg. 2021 Aug;141(8):1419-1423. doi: 10.1007/s00402-021-03770-x. Epub 2021 Mar 10.
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.
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.
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.
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.
拇指掌指关节不稳定可导致明显的功能障碍。由于儿童疼痛阈值高且韧带松弛，急性损伤通常容易被忽视。慢性损伤导致保守治疗失败。文献中对这种损伤的描述较少。我们研究的目的是确定诊断掌指关节不稳定的临床和影像学工具，并提出一种简单的手术技术来治疗这种损伤。
从 2015 年到 2019 年，我们展示了 4 例慢性创伤后拇指掌指关节不稳定的患者病例系列。通过临床和影像学检查（包括普通 X 线和超声检查）评估掌侧板撕脱情况。所有患者均采用掌侧入路进行手术修复，直接修复掌侧板。记录患者的人口统计学数据、并发症和临床结果。
平均随访 22.5 个月。在末次随访时，所有患者的掌指关节均稳定。除 1 例患者因缝线锚钉突出导致背侧短暂疼痛外，所有患者均无疼痛，该患者在 1 年随访时疼痛消失。他们的捏力均有所改善。所有患者均恢复了全范围的活动度，且均无活动受限，恢复到了完全正常的活动水平。
慢性创伤后拇指掌指关节不稳定会导致功能障碍。临床怀疑和超声评估可以证实诊断。在儿童中，经皮骨隧道缝线或锚钉固定术可获得满意的结果，同时保持正常的活动范围。
