Deep Transverse Metacarpal Ligament Reconstruction Using Suture Button and A1 Pulley

Rupture of the deep transverse metacarpal ligament (DTML) can result in pain, impaired grip strength, and undermine functional performance of the hand. We describe the case of a patient whose right hand came into contact with a boat propeller. He sustained a complete disruption of the DTML between the second and third ray in addition to soft tissue injury and open metacarpal fractures. Although other techniques describe a reconstruction of the DTML, our technique describes an adjunctive technique that strongly augments the A1 pulley reconstruction and nullifies the requirements of palmaris longus graft.