Variation in the Rate of Surgery for Ulnar Collateral Ligament Injury of the Metacarpophalangeal Joint of the Thumb

Stoop, Nicky; Teunis, Teun; Ring, David; Eberlin, Kyle R.

doi:10.1177/1558944716681974

Cited by 6 publications

(6 citation statements)

References 23 publications

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“…Additionally, our finding of a positive correlation between age and hospitalization rate in DUE fractures was corroborated by a 2010 study from France, which showed hospitalizations due to wrist fractures increased with age every year from 2002 to 2006 [ 9 ]. Age has been shown to be an independent risk factor for both worsened wrist function following certain DUE fractures and the need for surgical repair of DUE fractures [ 10 , 11 ]. Thus, increased aggressive treatment, including hospitalization and surgical repair, of DUE fractures in older adults is important for patient outcomes and is likely contributing to the trends seen in our paper.…”

Section: Discussionmentioning

confidence: 99%

Hospitalizations Are Increasing in Distal Upper Extremity Fractures

Brown,

Albers,

Tsirukis

et al. 2023

Cureus

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Introduction Distal upper extremity (DUE) fractures are common and include bony fractures of the wrist, hand, and finger. DUE fractures can require hospital admission for clinical observation or surgical fixation. The trend of hospitalization rate for these injuries may more accurately predict future staffing needs, required resources, and expected revenue for orthopedic surgery hand services. The purpose of this study is to determine the trend of hospitalization percentage from 2009 to 2018 for patients presenting to the United States (US) emergency departments (EDs) with DUE fractures. Methods The National Electronic Injury Surveillance System (NEISS) was utilized to collect data from 138,700 patients with wrist, hand, or finger fractures presenting to the US EDs between 2009 and 2018. A total of 752 patients were excluded for ages less than two years old or no sex entry. The unadjusted and adjusted (age, sex, race, and fracture location) hospitalization rates across years were evaluated using binary logistic regression. Results From 2009 to 2018, 137,948 DUE fractures were reported, of which 4749 (3.4%) were hospitalized. Wrist fractures accounted for the highest amount (2953) and the highest proportion of hospitalized patients (62.2%). Higher hospitalization rates were seen among patients 40 years and older (p < 0.05). Together, the DUE fracture hospitalization rate increased significantly (p < 0.05) in 2016 (OR = 1.215, 95% CI = 1.070-1.380), 2017 (OR = 1.154, 95% CI = 1.016-1.311), and 2018 (OR = 1.154, 95% CI = 1.279-1.638) from 2009. The adjusted results showed hospitalization rate statistically increased (p < 0.05) in 2016 (OR = 1.184, 95% CI = 1.040-1.346) and 2018 (OR = 1.389, 95% CI = 1.225-1.575) compared to 2009. An inconsistent increase in hospitalization rate was seen across locations of fracture: wrist (2012, 2013, 2018), hand (2018), and finger (2016, 2018). Conclusions The hospitalization rate of patients with DUE fractures increased in 2016 and 2018 from 2009. These data may predict a need to increase future staffing and resources for orthopedic surgery hand services as hospitals resume pre-pandemic practices.

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Section: Discussionmentioning

confidence: 99%

Hospitalizations Are Increasing in Distal Upper Extremity Fractures

Brown,

Albers,

Tsirukis

et al. 2023

Cureus

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“…The recent study by Stoop et al assessed 383 UCL injuries treated at three different hospitals in a singe American city 11 . In total, 30% of cases were avulsion fractures and 11% of cases were investigated with an MRI scan.…”

Section: Discussionmentioning

confidence: 99%

“…However some factors which were unrelated to patient characteristics were predictive of operative intervention, such as having an MRI and being treated by certain surgeons. It was felt that because the preoperative diagnosis of a Stener lesion has limited reliability and accuracy, the rates of surgery may vary based on surgeon beliefs, preferences and values.They also stated that ”some surgeons believe some non-Stener injuries benefit from operative treatment” 11 .…”

Section: Discussionmentioning

confidence: 99%

“…While there is evidence to support both the use of ultrasound and MRI, the latter appears slightly superior in terms of sensitivity and specificity 8 – 10 . A recent study by Stoop et al investigated which factors predict the chances of surgery in UCL injuries 11 . It was found that not only did patient characteristics influence the chances of surgery, but that the individual surgeon’s preference was also predictive.…”

Section: Introductionmentioning

confidence: 99%

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Therapeutic interventions for acute complete ruptures of the ulnar collateral ligament of the thumb: a systematic review

et al. 2018

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Background: The aim of this study was to evaluate the effectiveness of interventions for acute complete rupture of the ulnar collateral ligament (UCL) of the thumb in adults. Methods: The following databases were searched: MEDLINE and EMBASE via OVID, CINAHL and SPORTDiscus via EBSCO, from database inception to 31 st January 2018. Inclusion criteria were: (i) randomised controlled clinical trials (RCTs) or study of intervention with a comparator; (ii) participants with diagnosis of acute complete rupture of the UCL of the thumb; (iii) participants aged 18 years of age or older at enrolment; and (iv) published in a peer-reviewed English-language journal. Results: In total, six studies were identified for inclusion after screening. All studies had a high risk of bias. Three studies were retrospective comparative case series which compared two different surgical techniques (bone anchor versus pull out suture, suture versus pull out suture, suture versus steel wire). Of these studies, three were RCTs, two of which compared different rehabilitation regimes in patients managed surgically (plaster versus early mobilization, new spica versus standard spica). The remaining RCT compared two different rehabilitation regimes in a mixed group of surgically/non-surgically treated patients. The RCT comparing a standard spica with a new spica demonstrated a statistically significant improvement in outcomes with the new spica at all time points (range of motion, Dreiser index and VAS); this was also the only study to provide sufficient outcome data for further analysis. Conclusion: There is no prospective evidence comparing surgery to non-operative treatment for acute complete ruptures of the ulnar collateral ligament of the thumb. There is weak evidence to suggest that early mobilisation may be beneficial following surgical repair. Further research is necessary to better define which patients benefit from which specific interventions.

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“…In the case of associated avulsions, the degree of displacement or rotation are primary factors in deciding initial management. Avulsion fracture displacement >2 mm has been associated with patients needing to undergo surgery (42). In contrast to these findings, Dinowitz et al (38) found poor outcomes when managing UCL avulsion fractures with <2 mm displacement conservatively.…”

Section: Managementmentioning

confidence: 99%

Acute Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament Injury: Diagnosis, Management, and Return to Sports Considerations

Robinson

Jelsing

2023

Curr Sports Med Rep

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Thumb metacarpophalangeal joint ulnar collateral ligament injuries are common in athletes and range from mild sprains to complete retracted tears. The typical injury mechanism of a valgus force directed onto an abducted or extended thumb is frequently seen in certain sporting activities, such as skiing, football, and baseball. Ultrasound and magnetic resonance imaging are excellent imaging supplements to the clinical evaluation for diagnosis confirmation. Positive treatment outcomes have been demonstrated when these injuries are appropriately managed both nonoperatively and surgically. When deciding on a treatment plan, it is paramount to take the athlete's injury severity and sport-specific factors into account. The aim of this review is to summarize the sport epidemiology, diagnosis, treatment options, and return to play considerations for athletes who sustain an acute thumb metacarpophalangeal joint ulnar collateral ligament injury.

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Variation in the Rate of Surgery for Ulnar Collateral Ligament Injury of the Metacarpophalangeal Joint of the Thumb

Cited by 6 publications

References 23 publications

Hospitalizations Are Increasing in Distal Upper Extremity Fractures

Hospitalizations Are Increasing in Distal Upper Extremity Fractures

Therapeutic interventions for acute complete ruptures of the ulnar collateral ligament of the thumb: a systematic review

Acute Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament Injury: Diagnosis, Management, and Return to Sports Considerations

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