The influence of sex and trauma impact on the rupture site of the ulnar collateral ligament of the thumb

Abstract

Purpose and hypothesisAlthough sex- and gender-specific analyses have been gaining more attention during the last years they have rarely been performed in orthopaedic literature. The primary purpose of this study was to investigate whether for injuries of the UCL the specific location of the rupture is influenced by sex. A secondary study question addressed the sex-independent effect of trauma intensity on the rupture site of the UCL.MethodsThis study is a retrospective analysis of all patients with either a proximal or distal bony avulsion or with a mid-substance tear or ligament avulsion of the UCL treated surgically between 1992 and 2015 at two level-I trauma centres. Trauma mechanisms leading to the UCL injury were classified into the following categories: (1) blunt trauma (i.e., strains), (2) low-velocity injuries (e.g., fall from standing height, assaults), and (3) high-velocity injuries (e.g., sports injuries, motor vehicle accidents). After reviewing the surgical records, patients were divided into three groups, depending upon the ligament rupture site: (1) mid-substance tears, (2) proximal ligament or bony avulsions and (3) distal ligament or bony avulsions. Dependencies between the specific rupture site and the explanatory variables (sex, age, and trauma intensity) were evaluated using χ2 test and logistic regression analysis.ResultsIn total, 1582 patients (1094 males, 488 females) met the inclusion criteria. Mean age was 41 years (range: 9–90 years). Taking into account the effects of sex on trauma intensity (p<0.001) and of trauma intensity on rupture site (p<0.001), mid-substance tears occurred more frequently in women, whereas men were more prone to distal ligament or bony avulsions (p<0.001). In other words, sex and rupture site correlated due to the effects of sex on trauma intensity and of trauma intensity on rupture site, but taking into account those effects there still was a significant effect of sex on rupture site.ConclusionsThe results of this study demonstrate that with regression analysis both sex and trauma intensity allow to predict rupture site in UCL injuries.

Rupture Site Location of Surgically Treated Thumb Metacarpophalangeal Ulnar and Radial Collateral Ligaments

“…The above findings are in agreement with those published in smaller surgical case series dating from Stener’s original publication to the only other large surgical series published in 2017 by Boesmueller et al 26 in Austria. Table reviews the values seen in 15 studies.…”

“…Table reviews the values seen in 15 studies. 2 , 4 , 16 , 17 , 18 , 19 , 20 , 21 , 24 , 25 , 26 , 27 , 28 , 29 , 30 Across nearly 60 years of published data, the UCL has been shown to predominantly tear distally at the proximal phalanx insertion, and the RCL has a more heterogenous tear location, with tears occurring frequently at both the proximal metacarpal origins and distally at the phalangeal insertion.…”

Lesão de Stener: Avaliação Funcional após Tratamento Cirúrgico com Âncoras

“…No estudo feito por Chuter et al 22 avaliaram retrospectivamente 127 pacientes submetidos a tratamento cirúrgico de lesão do LCU, observando que 62% eram do sexo masculino. Boesmueller et al 23 . estudaram a influência do sexo no sítio de lesão e intensidade do trauma nas lesões do LCU.…”

“…Outro mecanismo importante em nosso estudo foi queda de moto (19,9%). No estudo de Boesmuller et al 23 o mecanismo de trauma mais comum foi relacionado a esportes (51%), principalmente esquiagem. Os autores atribuiram este dado ao fato de o estudo ter sido realizado na Austria, país procurado com frequência para prática deste esporte.…”

Airbag-Associated Bilateral Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament Injury

“…In a study looking at the effect of sex and trauma intensity in thumb UCL injuries, it was found that proximal tears were more often associated with low-velocity injury, as in our case, whereas high-velocity injury was associated more often with distal tears. 9 It is possible that proximal injury of the UCL is favored by the way a deploying airbag strikes the thumb in a low-velocity motor vehicle crash. High-velocity motor vehicle crashes may more likely result in the thumbs being injured by the steering wheel or other parts of the car interior, leading to midsubstance or distal UCL injuries.…”