![]() X-Ray findings are usually normal avulsion is uncommon. Radial Collateral Ligament Injuries Examination reveals ligamentous laxity on the radial aspect of the MCP joint, and local tenderness X-Ray may show an avulsion at the UCL insertion, or may be normalĮD Management involves application of a thumb spica (below) and arranging early follow-up with the Hand Surgery Team (regardless of whether avulsion present or absent)ĭefinitive Management is mostly not-operative with hand therapy, but some cases require surgical repair. Test the ligament by applying a valgus deformity to the MCP joint with thumb in slight flexion and also full extension: laxity of >35 degrees (or >15 degrees more than uninjured thumb) indicates UCL injury, regardless of Xray appearance . Skier's thumb) Usually results from hyperabduction of the thumb.Įxamination shows bruising and swelling to MCP joint, with focal tenderness to ulnar aspect of joint and pain there with pinch grip. Ulnar Collateral Ligament Injury/Avulsion (a.k.a. Management is as with a Bennett fracture, as it is usually subjected to the same deforming forces from the muscle insertions. Management is as with a Bennett Fracture above.įracture proximal shaft of metacarpal, usually from axial loading. ![]() X-ray: This example shows a Salter-Harris II fracture of the metacarpal. X-ray shows a small fragment of the metacarpal base articulating with the trapezium muscles attaching elsewhere on the main part of the metacarpal tend to pull it into subluxation.Įxamination will show bruising and tenderness at the thumb MCP jointĮD management involves immobilisation in a thumb-spica (see below) and arranging an appointment within a week with the hand surgery team (At RCH this is Plastic Surgery)ĭefinitive management by the hand surgery team requires reduction, usually involving K-wire insertionįracture through an open physis, involving the same mechanism and deformation patterns as in a Bennett fracture. What do they look like on x-ray?īennett Fracture, usually from axial loading of the thumb in patients with closed physes. True lateral, true AP and oblique views on XRay 6. What radiological investigations should be ordered? Subungual haematoma or displacement of the proximal edge of the nail plate out of the eponychial fold may indicate an underlying fracture.įindings for specific fracture types are listed in the table below 5. Rotational deformity can be assessed by comparison with the uninjured side, but is difficult to appreciate in the thumb. What do they look like - clinically?įractures of the thumb are usually associated with local bruising, swelling, pain and loss of function, with or without deformity. Hyperabduction of the thumb from either a fall or awkward contact from a ball whilst playing sports may result in a 'Skier's thumb' (UCL injury with or without bony avulsion from the base of P1)Īxial loading of the thumb may result in intra-articular metacarpal base fracture in the adolescent patient (Bennett or Rolando) 4. How common are they and how do they occur?Ĭrush mechanism (for example in doorways) is particularly common in younger children, often resulting in tuft fractures or less commonly Seymour fractures , and may be associated with a nailbed injury Specific fracture types are shown in point 6 below. By particular fracture pattern (UCL injury/Skier's thumb, Bennett's fracture) By presence or absence of growth plate involvement (Salter Harris classification), By location (distal or proximal phalanx, or metacarpal), Other fractures are managed in the same way as fractures of the other digits: please consult 2. This guideline covers types of thumb fracture that require specific management which differs from fractures of other digits. Most simple fractures can be immobilised in a thumb spica splint and followed up in an appropriate hand surgery clinic Careful early detection and management of thumb injuries in the ED is important for minimising any long-term morbidity associated with the injury Normal thumb function is an essential part of many activities of daily living, leisure activities and future occupational function.
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