[Skier's thumb injury in the child]

Acute rupture of the ulnar collateral ligament (UCL) of the metacarpophalangeal joint of the thumb (skier's thumb) is a common skiing injury in adults. Do we find this injury in children? Of the 302 skier's thumbs during the last 4 years we found 24 (8%) injuries in children (mean age 13.4 years) with open growth plates. They had the following diagnosis and consecutive treatment: 5 partial ruptures of the UCL, 3 Salter I and 6 Salter II fractures with radial fragment of the proximal phalanx I; all these had conservative treatment. In addition one had a Salter III fracture with open reduction and fixation, 6 avulsion fractures, which were treated twice operatively and 4x conservatively and 3 ruptures of the ligament which needed reconstruction. Supposing the trauma mechanism in adults, we see a different, age-dependent injury pattern in children. The younger had Salter-I- and Salter-II-lesions of the proximal phalanx, where as the adolescents showed avulsion fractures and ruptures of the UCL as seen in adults. The follow-up of 17 cases minimally 1 year after the accident showed in 12 a full recovery, in 4 cases small subjective symptoms but full function and in 1 case an ankylosis of the MCP-joint following a postoperative infection.