The management of acute complete ruptures of the ulnar collateral ligament of the thumb.

Mikhail, M.; Riley, N.; Rodrigues, J.; Carr, E.; Horton, R.; Beale, N.; Beard, DJ.; Dean, BJF.; Clubb, L.; Johnstone, A.; Lawrie, D.; Imam, M.; Joyce, S.; Ankarth, S.; Capp, R.; Dayananda, K.; Gape, N.; Trickett, R.; Bremner-Smith, A.; Chan, C.; Eckersley, R.; Horwitz, M.; Jatan, A.; Lumsdaine, W.; McArthur, G.; Mee, S.; Banks, L.; Dean, S.; Dehbozorgi, S.; Green, K.; Meh, S.; Fawkes, F.; Rooker, J.; Bell, H.; Vaghela, K.; Fournier, K.; Kennedy, D.; Li, L.; Srinivasan, S.; Gamble, D.; Gerakopoulos, E.; Groves, J.; Jackson, T.; Karuppaiah, K.; Maltby, A.; Nair, A.; Reichert, I.; Bains, R.; Mariathas, C.; Reilly, F.; Sharpe, L.; Wildin, C.; Feeney, M.; Kulkarni, A.; Sharma, V.; Flaherty, S.; Gough, A.; Hamlin, K.; King, L.; Law, C.; Johnson, S.; Svee, C.; Khan, Y.; Rodgers, S.; Storey, P.; Dean, B.; Sander-Danby, L.; Shields, K.; Torkington, M.; Blackshaw, R.; Chaudhry, T.; Jordan, L.; Wu, F.; Clarke, D.; Robinson, E.; Thumbadoo, R.; Parkinson, M.; Sharpe, K.; Allen, M.; Poulter, R.; Currie, J.; Stone, O.; Cliff, N.; Duckworth, A.; Cowey, A.; Crossfield, J.; Giddins, G.; Heath, R.; Langdon, I.; Mgbemena, L.; Mills, R.; Pickering, G.; Sheriff, M.; McDonough, A.; Naqui, Z.; Lyons, N.; Reay, E.; Taylor, T.; Bates, M.; Eastwood, G.; McLoughlin-Symon, I.; Ramesh, A.; Chan, J.; Govilkar, P.; Shirley, R.; Upson, C.; Sajid, S.; Langley, C.; Higgins, J.; Armstrong, A.; Gujral, S.; Howe, A.; Ip, M.; Thornsby, J.; Slade, R.; Knowles, L.; Lipscombe, S.; Goggins, T.; Talwalkar, S.

The management of acute complete ruptures of the ulnar collateral ligament of the thumb.

All Authors

Mikhail, M.

Riley, N.

Rodrigues, J.

Carr, E.

Horton, R.

Beale, N.

Beard, DJ.

Dean, BJF.

Clubb, L.

Johnstone, A.

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LTHT Author

Bains, Robert
Mariathas, Chrishan
Reilly, Fiona

LTHT Department

Plastic & Reconstructive Surgery
Orthopaedics

Non Medic

Physiotherapist

Publication Date

2024

Item Type

Journal Article

Abstract

Aims: Complete ruptures of the ulnar collateral ligament (UCL) of the thumb are a common injury, yet little is known about their current management in the UK. The objective of this study was to assess the way complete UCL ruptures are managed in the UK. Methods: We carried out a multicentre, survey-based cross-sectional study in 37 UK centres over a 16-month period from June 2022 to September 2023. The survey results were analyzed descriptively. Results: A total of 37 centres participated, of which nine were tertiary referral hand centres and 28 were district general hospitals. There was a total of 112 respondents (69 surgeons and 43 hand therapists). The strongest influence on the decision to offer surgery was the lack of a firm 'endpoint' to stressing the metacarpophalangeal joint (MCPJ) in either full extension or with the MCPJ in 30degree of flexion. There was variability in whether additional imaging was used in managing acute UCL injuries, with 46% routinely using additional imaging while 54% did not. The use of a bone anchor was by far the most common surgical option for reconstructing an acute ligament avulsion (97%, n = 67) with a transosseous suture used by 3% (n = 2). The most common duration of immobilization for those managed conservatively was six weeks (58%, n = 65) and four weeks (30%, n = 34). Most surgeons (87%, n = 60) and hand therapists (95%, n = 41) would consider randomizing patients with complete UCL ruptures in a future clinical trial. Conclusion: The management of complete UCL ruptures in the UK is highly variable in certain areas, and there is a willingness for clinical trials on this subject.