A technique to reconstruct the deep transverse metacarpal ligament

Abstract

extension of the digit. The operation usually takes less than 1 min (not including anaesthesia).A total of 86 trigger fingers or thumbs (67 thumbs, 1 index finger, 10 middle fingers, 6 ring fingers, and 2 little fingers) in 70 patients were treated using this method between March 2005 and August 2010. Of the 70 patients, 56 had a single trigger digit, 13 had 2 trigger digits, and 1 had 4 trigger digits. Eighty-three digits (97%) were completely released during the first procedure, two digits required two procedures, and one digit required open release. Therefore, eventually 85 of 86 digits (99%) obtained a satisfactory result using our minimally invasive needle-knife. There were no injuries to the flexor tendons, common palmar digital arteries and nerves, or the superficial palmar arch during any of the procedures. Additionally, none of the patients suffered from loss of finger flexion or flexor bowstring following the procedure. The average cost was only €39 (£32; $50 US) per patient.The minimally invasive needle-knife overcomes the disadvantages of previously reported knives, such as difficulty in dividing a thickened pulley, and the requirement for inserting the tip of the knife into the A1 pulley (Chung et al., 2006; Ha et al., 2001).

Nonsurgical treatment of deep transverse metacarpal ligament injuries

“…The suggestive findings of DTML injury are pain, decreased grip strength, deflection and diastasis of the affected fingers that becomes more evident with digital flexion. 2,4 Magnetic resonance imaging (MRI) does not have a clear role in the diagnosis of the lesión because it is difficult to visualize the DTML, but it aids when the lesion is suspected and also allows ruling out collateral metacarpophalangeal ligament injuries. 1,3,7,8 In the literature, several surgical techniques for its reconstruction have been described.…”

“…This case was also treated surgically by palmaris longus tendon graft and Kirschner wires. 2,4 Josty et al 1 described a case of DTML injury affecting both sides of the 4th metacarpal generating hypermobility of the head of this bone, which was surgically resolved by DTML reconstruction with A1 pulley of the adjacent fingers and stabilization with pins. 1 In our experience, we evaluated the evolution of two patients who presented this injury diagnosed in acute and treated conservatively.…”

“…[1][2][3] Injuries of this ligament due to blunt trauma produce DTML injury and present with pain, decreased grip strength, deflection and diastasis of the affected fingers. 2,4 Several surgical techniques for its reconstruction have been described. [1][2][3][4] The aim of this paper is to evaluate the evolution of two patients who presented this injury diagnosed in acute and treated conservatively.…”

“…2,4 Several surgical techniques for its reconstruction have been described. [1][2][3][4] The aim of this paper is to evaluate the evolution of two patients who presented this injury diagnosed in acute and treated conservatively.…”