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Splint immobilization of gamekeeper's thumb
J C Landsman1, W H Seitz, A I Froimson
1Department of Orthopedic Surgery, Mt Sinai Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
Orthopedics
|December 1, 1995
Summary
Thumb metacarpophalangeal joint ulnar collateral ligament ruptures can effectively heal with thumb spica splint immobilization. Surgical intervention is reserved for the minority of cases with persistent instability after non-operative treatment.
Area of Science:
- Orthopedic Surgery
- Sports Medicine
- Hand Surgery
Background:
- Acute complete ruptures of the ulnar collateral ligament (UCL) of the thumb metacarpophalangeal (MCP) joint are common injuries.
- Current treatment guidelines often recommend surgical intervention for these injuries.
Purpose of the Study:
- To evaluate the efficacy of primary thumb spica splint immobilization for acute complete UCL ruptures of the thumb MCP joint.
- To determine if non-operative management can reduce the need for surgical reconstruction.
Main Methods:
- A retrospective study of 39 patients (40 injuries) with acute complete UCL ruptures of the thumb MCP joint treated with thumb spica splint immobilization for 8-12 weeks.
- Patients were followed for 1-5 years to assess for instability, arthrosis, pain, and stiffness.
Main Results:
- 85% of injuries (34/40) healed without significant instability, arthrosis, pain, or stiffness.
- 15% of injuries (6/40) demonstrated persistent instability and pain at 12 weeks, requiring surgical reconstruction.
- Surgical reconstruction in the minority of cases yielded excellent results.
Conclusions:
- Thumb spica splint immobilization is an effective primary treatment for acute complete UCL ruptures of the thumb MCP joint.
- Current guidelines for surgical intervention may need revision, as non-operative management is successful in the majority of cases.
- Surgical reconstruction remains a viable option for persistent instability with excellent outcomes.