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Introduction: Digital collateral ligament injuries are common hand injuries that can cause significant pain and functional impairment. Ultrasonography can be useful in the evaluation of these ligamentous injuries, as it is both cost-effective and allows for easy, dynamic evaluation during imaging. Case report: We report a rare sonographic finding of an index finger radial collateral ligament injury that was found to have a flap of the ligament entrapped within the metacarpophalangeal joint, which to our knowledge has not been described previously. We correlate this finding with an intraoperative image of the entrapment of the collateral ligament. We also report on the novel application of superb microvascular imaging to aid in the diagnosis of digital collateral ligament injury. Discussion: This particular injury pattern has not been reported in the literature previously and likely explains the patient's lack of improvement with nonoperative management. Our finding is similar to a Stener lesion seen in a thumb ulnar collateral ligament injury in which the ligament is unable to heal due to entrapment. In addition, using superb microvascular imaging (SMI), we were able to visualize hyperemia to surrounding structures and the ligament itself which suggested an acute injury. Conclusion: We anticipate that this case report will provide sonographers with knowledge and images of this specific injury pattern to the digital collateral ligaments. [ABSTRACT FROM AUTHOR]

A Stener lesion is a displaced tear of the ulnar collateral ligament in the metacarpophalangeal joint of the thumb in which the adductor pollicis aponeurosis is positioned between the retracted ligament and the injury site, preventing natural healing. This lesion was first described in 1962, and since then, both radiologists and orthopedists have considered it important to treat surgically. Although this lesion was originally described in the thumb, this injury mechanism can occur in other joints of the hand, knee, and foot. The purpose of this study was to review the relevant aspects of classic Stener lesions of the thumb, as well as other Stener-like lesions, including their anatomy, mechanisms of lesion formation and imaging features. The Stener-like injury pattern often necessitates surgical repair or reconstruction; thus, it is essential that radiologists recognize and report the different patterns of injury. • Ligament injuries in other parts of the body can exhibit similar mechanisms to that of Stener lesions, with surgical implications. • Knowledge of the anatomy and the sites that may be involved are essential so that a Stener-like lesion is not overlooked. • Lateral collateral ligament at the first metatarsophalangeal joint, 5th metacarpophalangeal joint and medial knee are sites with similar mechanisms of lesion formation. [ABSTRACT FROM AUTHOR]

• Case report of collateral ligament injury with metacarpal head fracture in a near amputation after power saw injury. • Special attention for treatment. The early reparation, reconstruction and fixation with screws in a convergent system procedure was the treatment of choice in this condition. • Intra-articulation union of a metacarpal head fracture and the good function of metacarpophalangeal joints (MCP) joint at the 1-year follow-up. The incidence of thumb amputation is high in developing and industrialized countries. A power saw injury is very traumatic to the soft tissue and neurovascular system, and thus difficult for orthopedic and plastic surgeons to treat. A 41 year old male injured his right hand with a power saw. The poor condition of the soft tissue and collateral ligament damage to the head of the metacarpal fracture meant that near amputation was a possibility. The patient received adequate antibiotic and was taken to the operating room for fixation with convergent screws system, repaired and reconstructed collateral ligament complex. At 3 month follow up, author saw the union of the intraarticular fracture and the metacarpophalangeal joint (MCP). The patient was followed up at 1 year, the sensory and function was full recovered. The patient was extremely satisfied with this treatment and can now work normally again. The collateral ligament complex injury with metacarpal head fracture in a near amputation after power saw injury; it is a very unstable injury. In this case, author performed an early adequate intravenous antibiotics in the emergency room and was taken to the operating room for repair and reconstruction. Neurological status and hand function were recovered that patient was extremely satisfied in this surgical planning. The power saw injury is a severe injury which requires special attention for treatment. Furthermore, the early reparation, reconstruction and fixation with screws in a convergent system is the treatment of choice in this condition. [ABSTRACT FROM AUTHOR]

Study Design Prospective cohort. Introduction and Purpose This study evaluates the factors influencing treatment outcomes of proximal interphalangeal (PIP) joint collateral ligament injuries when treated with buddy strapping. Methods Sixty-seven patients treated with buddy strapping for a PIP joint injury were enrolled. The finger range of motion (ROM), grip strength, and a Quick Disability of the Arm, Shoulder, and Hand (QuickDASH) score were assessed at 3 and 6 months after the initial injury. The factors that were assessed for their influence on the functional outcomes included age, sex, hand dominance, affected finger, type of injury, injury severity, time to treatment, the duration of buddy strapping, and exercise training. Results Buddy strapping for PIP joint injuries led to satisfactory results with 77% recovery of grip strength, 84% recovery in ROM, and mean QuickDASH scores of 14 at 6 months. A decrease in grip strength was associated with an increase in age and injury severity at 6 months, and these 2 factors accounted for 22% of the variance in the grip strength. A decrease in ROM was associated with the delayed treatment, which accounted for 18% of the variance in ROM at 6 months. An increased disability was associated with delayed treatment, female gender, and radial digit injury at 3 months, and these 3 factors accounted for 37% of the variance in disability. At 6 months, only the delayed treatment remained an associated factor, which accounted for 20% variance in disability. Discussion and Conclusions PIP collateral ligament injuries had very good outcomes with buddy strapping. However, delayed treatment was significantly associated with poor functional outcomes in terms of the ROM and disability. An increase in age and injury severity were associated with lower grip strength up to 6 months, whereas a female gender and radial digit injury were associated with an increased disability up to 3 months. Level of evidence 2 [ABSTRACT FROM AUTHOR]

Purpose: There has been few published on arthroscopy of metacarpophalangeal joint (MCPJ) despite increasingly being used worldwide. The purpose of this study was to investigate the effectiveness of arthroscopy for pathologies around MCPJ of the thumb. Methods: Between September 2007 and June 2015, 56 patients (56 thumb) who underwent arthroscopy of the MCPJ were retrospectively studied. Preoperative diagnoses, which were made through physical examination, plain radiograph, stress radiography, ultrasound, and magnetic resonance images (MRI), were compared with arthroscopic findings. Therapeutic arthroscopic surgeries were performed according to the needs of each patient. Functional outcomes were assessed with physical examination as well as disabilities of the arm, shoulder and hand (DASH) score and Michigan Hand outcomes Questionnaire (MHQ) score at an average 7.3 months follow-up. Results: Six patients who suspected with collateral ligament injuries in MRI confirmed different diagnoses under arthroscopy. At final follow-up, the mean range of flexion contracture of the MCPJ was 5°, and the mean range of further flexion was 52.7°. Grip and pinch strength averaged 87.2% and 79.3% of contralateral side. Mean DASH and MHQ score were improved from 48.1 and 44.6, preoperatively to 14.9 and 26.3, postoperatively (p<0.001, p=0.012, respectively). All patients were satisfied with their outcomes at final follow-up, except 4 patients who noted joint stiffness or chronic pain around the thumb. Conclusion: Our results revealed that arthroscopy is helpful for both diagnostic and therapeutic purposes of acute and chronic painful MCPJ of the thumb. However, further studies are needed to expand the applications of arthroscopy of MCPJ of the thumb. [ABSTRACT FROM AUTHOR]

Background Despite an improved understanding of coronoid anteromedial facet (AMF) fractures, the optimal treatment protocol and technique have not yet been established. The goals of the study were to describe the characteristics of AMF fractures, to suggest a surgical strategy, and to report the outcomes after treatment according to this protocol. Methods This was a retrospective study of 19 patients with AMF fractures between 2010 and 2012. Eight patients were excluded because of secondary olecranon fracture, radial head fracture, and elbow dislocation, leaving 11 patients with isolated AMF fracture in the study cohort. There were 7 men and 4 women, with an average age of 42 years (range, 29-62 years). Fracture classification, injury pattern, and accompanying collateral ligament injury were analyzed. O'Driscoll subtype 1 fractures were treated with lateral collateral ligament (LCL) repair; O'Driscoll subtype 2 and subtype 3 fractures were treated with buttress plating and LCL repair. Plain radiographs were used to evaluate union, arthritic change, and joint articulation. Functional outcomes were evaluated with range of motion and the Mayo Elbow Performance Score. Results Two patients had O'Driscoll anteromedial subtype 1 fracture, 4 patients had subtype 2, and 5 patients had subtype 3. Two patients with subtype 1 fracture had associated posterior dislocation; 9 patients with subtype 2 or subtype 3 had associated varus posteromedial injury. All 11 patients had associated LCL injury, and 6 patients had associated medial collateral ligament injury. The mean range of motion was 128°, and the average Mayo Elbow Performance Score was 89 points. Qualitatively, patient outcomes were scored excellent in 4 patients, good in 6 patients, and fair in 1 patient. Conclusion AMF fractures are almost always accompanied by collateral ligament injuries. Thus, our surgical strategies, which include collateral ligament repair, are able to stabilize and result in favorable clinical outcomes. On the basis of our results, we recommend LCL repair alone for subtype 1 fractures and buttress plating and LCL repair for subtype 2 and subtype 3 fractures. [ABSTRACT FROM AUTHOR]

Purpose: To assess the normal degree of laxity of the collateral ligaments (CLs) of the finger metacarpophalangeal (MCP) joints and to compare side-to-side differences in CL laxity. Methods: One hundred subjects had measurements of the degree of laxity in the radial (RCL) and ulnar (UCL) collateral ligaments of the MCP joints of each digit on both hands with the joints at neutral and at 30° and 90° of flexion using a custom-made measuring device. Statistical analysis was performed to assess both the difference in laxity for each ligament at each position of flexion and between sides for analogous ligaments (eg, the right index RCL at neutral compared to the left index RCL at neutral). Results: There was a significant decrease in laxity for all ligaments between neutral (mean, 24° laxity) and 90° of flexion (mean, 15° laxity). There was a side-to-side difference between the RCL of all digits in extension (mean, 3°) and the index RCL in flexion (2°). These differences were statistically significant but clinically minimal. There were no side-to-side differences between any of the other ligaments at any position. Conclusions: Finger MCP joint CL stability increases with increasing flexion of the joint. There is little to no difference between analogous ligaments on either hand of the subject when tested in the same position of MCP joint flexion. Knowledge of the average degree of MCP joint CL laxity can be helpful in assessing a potentially injured joint. A patient’s contralateral, uninjured side can be used to determine that individual’s normal laxity and a substantial increase from this on an injured digit can indicate CL rupture. Type of study/level of evidence: Diagnostic II. [Copyright &y& Elsevier]

Background: MRI has been shown to be highly accurate in assessing collateral ligament injuries of the metacarpophalangeal joint (MPJ) of the thumb. The purpose of this study is to evaluate the accuracy of MRI for diagnosing collateral ligament tears of the MPJ of the fingers. Our hypothesis is that MRI would accurately detect complete tears of collateral ligaments of the lesser digit MPJs. Methods: We retrospectively evaluated 22 digits in 20 patients undergoing finger MPJ collateral ligament repair. All patients had preoperative MRI scans. The findings on preoperative imaging studies were compared to the intraoperative findings. Results: All patients had surgically confirmed complete tears of the collateral ligament in question. In 8 of 22 MRI scans (36 %), the preoperative imaging study was inaccurate. Of these eight patients, MRI was interpreted as no tear in one and a partial tear in seven. The sensitivity of MRI for diagnosing a complete tear was 64 %. In all three digits in which 3-T MRI scanning was utilized and documented, the preoperative imaging results did not correlate with the intraoperative findings. Conclusions: Although MRI can be considered a useful adjunct to evaluating patients with collateral ligament injuries of the fingers, the sensitivity is poor and the imaging results can underestimate the extent of injury. In light of this, the emphasis for determining appropriate course of treatment remains on history and mechanism of injury, physical examination, and patient disability. [ABSTRACT FROM AUTHOR]

We report four cases of palmar dislocation of the thumb metacarpophalangeal joint and review of an additional 22 cases in the literature. Our four cases were associated with ligamentous injuries that prevented stable closed reduction. The patients were treated with open reduction and ligament repair and ultimately had a decreased range of motion. Our four cases and the 22 cases from literature fall into three types: Type A – stable joint (the metacarpophalangeal joint is stable, without severe ligament injury); Type B – tendon block (palmar displaced extensor tendons within the metacarpophalangeal joint prevents reduction); and Type C – joint instability (the metacarpophalangeal joint is unstable because of severe collateral ligament disruption). Type B is the most commonly reported type of palmar dislocation of the thumb metacarpophalangeal joint, with distinct features of the involvement of the collateral ligaments and failure of attempted manual reduction. The patients without severe collateral ligament disruption were managed with conservative treatment. The patients with interposition of extensor tendons and the patients with instability resulting from severe ligamentous injuries require surgical treatment. [ABSTRACT FROM PUBLISHER]

The elbow is a complex hinge joint relying on bony and soft tissue restraints for stability. The primary soft tissue stabilizers are the medial and lateral collateral ligament complexes. Injury to these structures may occur because of an elbow dislocation or due to a severe varus or valgus force. Most injuries are treated conservatively, but when associated with more severe soft tissue and bony injuries around the elbow, surgical repair or reconstruction may be required. Repair should be anatomical and should restore stability to the elbow so that early active range of motion can be initiated. Reconstruction may be required in severe cases and where primary repair is not possible. Knowledge of the normal anatomy and understanding the pathoanatomy is crucial to achieving a good result. Depending on the degree of instability, either one or both of the collateral ligament complexes may need to be repaired or reconstructed. When reconstruction is required, usually only the lateral ulnar collateral and the anterior band of the medial collateral ligament need to be reconstructed, but when severely unstable, the posterolateral capsule and the posterior band of the medial collateral ligament may also require reconstruction. This may be accomplished by 2 separate grafts or as a single circumferential graft. Arthroscopy is a valuable tool to assess the stability as well as to identify and treat associated injuries. This article describes the normal and pathoanatomy of the unstable elbow and outlines the surgical techniques for repair and reconstruction of the collateral ligaments. [Copyright &y& Elsevier]

Trauma can render the elbow unstable via a combination of bone and ligament injuries. Some of these injuries feature subluxation rather than dislocation of the elbow. Effective treatment centers on restoring enough of the bony and ligamentous structures to keep the elbow in joint so that recovery can proceed as for a simple elbow dislocation. Recognition of distinct patterns of injury can help determine the structures injured and the best methods for repairing them. [Copyright &y& Elsevier]

Background: In patients suffering from an anterior cruciate ligament injury, the incidence and location of bone bruises are well documented. This study reports data regarding bone bruises after acute posterior cruciate ligament injury. Hypothesis: Bone bruises associated with posterior cruciate ligament injury are common, and their location differs from those seen with anterior cruciate ligament injury. Study Design: Retrospective cohort study. Methods: Thirty-five consecutive patients were identified as having a grade II or Ill posterior cruciate ligament tear, with an intact anterior cruciate ligament, in which a magnetic resonance imaging scan had been obtained within 20 days of injury. Magnetic resonance imaging scans were reviewed to document bone bruises, associated medial or lateral ligamentous injury, and meniscal and chondral abnormalities. Results: Of the 35 patients, 29 (83%) had a bone bruise in at least one location. Bone bruises were found throughout the joint, more widely dispersed than is commonly seen with anterior cruciate ligament injury. Also, 29 patients had magnetic resonance imaging findings of associated ligamentous injury. Lateral bone bruises were associated with medial collateral ligament injury, whereas medial bone bruises correlated with posterolateral injury. Conclusions: The incidence of bone bruises associated with posterior cruciate ligament injury is similar to that seen with anterior cruciate ligament injury. Their location is more widely dispersed. The location of a bone bruise should lead to careful magnetic resonance imaging inspection and physical examination for ligamentous injury to the opposite side of the joint. Truly isolated posterior cruciate ligament injuries are rare, as most occur with osseous and some degree of associated ligamentous injury. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this study was to study the association of anterior cruciate ligament (ACL) injury with meniscal, collateral ligament, and bone injuries using magnetic resonance imaging (MRI) for clinical correlation during ACL repair. Methods This was a retrospective cohort study conducted on 136 patients diagnosed with ACL injury by MRI at King Abdulaziz University Hospital (KAUH) between September 2010 and September 2018. Results The medial meniscus was injured in approximately half (49.3%) of patients, while the lateral meniscus was injured in 16.2%. Regarding collateral ligament injuries, the medial collateral ligament was injured in six patients (4.4%), the lateral collateral ligament in four patients (2.9%), and both collateral ligaments in three patients (2.2%). There was a significant relationship between the age group and the side of ACL injury (P<0.05) but not between the age group and the presence of an associated injury. Conclusion There was no significant relationship between ACL injury and menisci, collateral ligament, or bone injury., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2020, Tayeb et al.)

We report four cases of palmar dislocation of the thumb metacarpophalangeal joint and review of an additional 22 cases in the literature. Our four cases were associated with ligamentous injuries that prevented stable closed reduction. The patients were treated with open reduction and ligament repair and ultimately had a decreased range of motion. Our four cases and the 22 cases from literature fall into three types: Type A - stable joint (the metacarpophalangeal joint is stable, without severe ligament injury); Type B - tendon block (palmar displaced extensor tendons within the metacarpophalangeal joint prevents reduction); and Type C - joint instability (the metacarpophalangeal joint is unstable because of severe collateral ligament disruption). Type B is the most commonly reported type of palmar dislocation of the thumb metacarpophalangeal joint, with distinct features of the involvement of the collateral ligaments and failure of attempted manual reduction. The patients without severe collateral ligament disruption were managed with conservative treatment. The patients with interposition of extensor tendons and the patients with instability resulting from severe ligamentous injuries require surgical treatment.