Ulnar collateral ligament injuries of the thumb: 10 years of surgical experience

Over 10 years in our unit, 127 patients underwent surgical repair of an acute thumb ulnar collateral ligament (UCL) rupture for clinically unstable injuries or displaced avulsion fractures. Ultrasound was used when clinical diagnosis was uncertain. The male/female ratio was 3:2, with a mean age of 40 years (range: 12-81 years). Most of them (> or =66%) were hyper-extension/abduction injuries. The most common cause was a fall (49%), followed by sports injuries; skiing accounted for only 2.4%. Ultrasound was 92% sensitive for UCL ruptures (positive predictive value (PPV) 99%). Over 99% of patients had a UCL rupture confirmed at surgery. Other findings included avulsion fractures (21%), dorsal capsular tears (57%) and dorsal capsule infolding (29%). The most common surgical complication was neurapraxia (6.5%). In our population, thumb UCL injuries are rarely caused by skiing. Ultrasound is a useful, sensitive adjunct in acute diagnosis. Dorsal capsular tears and joint interposition are common. Surgery provides excellent results with few long-term complications.