The Neglected Rupture of Deep Transverse Metacarpal Ligament

Abstract

The deep transverse metacarpal ligament (DTML) extends in radio-ulnar direction between the palmar plates of the metacarpophalangeal (MCP) joints of the second through fifth finger rays. On the radial aspect of the index and the ulnar aspect of the small fingers, the ligament merges with the collateral ligament of the MCP joints. The ligament has palmar grooves for the flexor tendons at the MCP joints and act as a support for the metacarpal arch. Closed DTML injury is an unusual case, but the physical findings of DTML injury are a decrease in grip strength, deviation of the finger in flexion and pain on the affected site of the hand. We have experienced a case of neglected DTML injury of left third interdigital space in a 23-year-old man.

Reconstruction of Disruptions of the Deep Transverse Metacarpal Ligament of the Ring Finger Using the A1 Pulleys

“…Forceful blunt injury to the ulnar side of the hand was the causative factor in this and the three previously reported cases (Lee et al, 2003; Wheatley et al, 1998;). In contrast to the previously published cases, our patient did not present with an abduction deformity of his ring or little finger.…”

“…However, direct repair may not be possible in severe or long standing injury. Lee et al (2003) describe a patient in whom they reconstructed the portion of the ligament between the ring and middle finger metacarpals using a palmaris longus tendon graft and K-wire stabilisation, via a dorsal approach. In this case, we used a modification of the A1 pulley turnover technique originally described in congenital hand surgery (Ogino, 1990), with K-wire stabilisation.…”

“…Wheatley et al (1998) described forceful blunt injuries causing disruption of this ligament between the ring and little finger rays in two patients who presented with painful ulnar deviation of the little finger in full active extension. More recently, Lee et al (2003) reported another patient who presented with reduced grip and ulnar deviation of the ring finger in flexion secondary to disruption of this ligament between the middle and ring finger rays.…”

“…The index and middle finger metacarpals are relatively fixed, but the ring and little finger metacarpals are more mobile, enabling movement of the arch and either cupping or flattening of the palm. Disruption of this ligament is an unusual injury (Lee et al, 2003; Wheatley et al, 1998). Wheatley et al (1998) described forceful blunt injuries causing disruption of this ligament between the ring and little finger rays in two patients who presented with painful ulnar deviation of the little finger in full active extension.…”

A technique to reconstruct the deep transverse metacarpal ligament

“…This technique has also been used following trauma (Josty et al, 2006). Lee et al (2003) used a loop of palmaris longus tendon anchored through bony tunnels to reconstruct the DTMLs and the temporary use of transverse K-wires to support this reconstruction.…”