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. 2024 Aug 22;5(8):708-714.
doi: 10.1302/2633-1462.58.BJO-2024-0062.R1.

The management of acute complete ruptures of the ulnar collateral ligament of the thumb

Mark Mikhail  1   2 , Nicholas Riley  1   3 , Jeremy Rodrigues  4   5 , Elaine Carr  6 , Robin Horton  7 , Nicholas Beale  8 , David J Beard  8 , Benjamin J F Dean  1   8 ; UCL TEAR Collaborative; Lucy Clubb  9 , Alan Johnstone  9 , David Lawrie  9 , Mohamed Imam  10 , Sarah Joyce  10 , Sudhi Ankarth  11 , Rachel Capp  12 , Kathryn Dayananda  12 , Nick Gape  12 , Ryan Trickett  12 , Alice Bremner-Smith  13 , Carol Chan  13 , Rupert Eckersley  13 , Maxim Horwitz  13 , Anita Jatan  13 , William Lumsdaine  13 , Gordon McArthur  13 , Sarah Mee  13 , Louisa Banks  14 , Sally Dean  14 , Sasan Dehbozorgi  14 , Kate Green  14 , Sonu Meh  14 , Francesca Fawkes  15 , Jemma Rooker  15 , Hannah Bell  16 , Kalpesh Vaghela  16 , Katia Fournier  17 , Donna Kennedy  17 , Lily Li  17 , Suresh Srinivasan  18 , David Gamble  19 , Efstratios Gerakopoulos  19 , Jordyn Groves  19 , Thomas Jackson  19 , Karthik Karuppaiah  19 , Amy Maltby  19 , Anjali Nair  19 , Ines Reichert  19 , Robert Bains  20 , Chrishan Mariathas  20 , Fiona Reilly  20 , Laura Sharpe  21 , Clare Wildin  21 , Michael Feeney  22 , Avadhut Kulkarni  22 , Vikas Sharma  22 , Sarah Flaherty  23 , Anthony Gough  23 , Katharine Hamlin  23 , Lorraine King  23 , Cherry Law  23 , Simon Johnson  24 , Cyndi Svee  24 , Yasmeen Khan  25 , Sarah Rodgers  26 , Phil Storey  26 , Ben Dean  27 , Lizelle Sander-Danby  27 , Karen Shields  28 , Matthew Torkington  28 , Rachel Blackshaw  29 , Tahseen Chaudhry  29 , Lisa Jordan  29 , Feiran Wu  29 , David Clarke  30 , Elena Robinson  30 , Ruben Thumbadoo  30 , Miriam Parkinson  31 , Kevin Sharpe  31 , Matt Allen  32 , Rob Poulter  32 , Jamie Currie  33 , Oliver Stone  33 , Nicola Cliff  34 , Andrew Duckworth  34 , Alex Cowey  35 , James Crossfield  35 , Grey Giddins  35 , Robyn Heath  35 , Ilana Langdon  35 , Lydia Mgbemena  35 , Rebecca Mills  35 , Greg Pickering  35 , Mark Sheriff  35 , Andrew McDonough  36 , Zaf Naqui  36 , Nicole Lyons  37 , Emma Reay  37 , Tracey Taylor  38 , Michelle Bates  39 , Gillian Eastwood  39 , Iain McLoughlin-Symon  39 , Ashwanth Ramesh  39 , James Chan  40 , Prashant Govilkar  40 , Rebecca Shirley  40 , Claire Upson  40 , Soha Sajid  41 , Elaine Carr  42 , Claire Langley  42 , Joanna Higgins  43 , Alexander Armstrong  44 , Sameer Gujral  44 , Aimee Howe  44 , Mina Ip  44 , Janette Thornsby  44 , Robert Slade  44 , Laura Knowles  45 , Stephen Lipscombe  45 , Theresa Goggins  46 , Sumedh Talwalkar  46
Affiliations

The management of acute complete ruptures of the ulnar collateral ligament of the thumb

Mark Mikhail et al. Bone Jt Open. .

Abstract

Aims: Complete ruptures of the ulnar collateral ligament (UCL) of the thumb are a common injury, yet little is known about their current management in the UK. The objective of this study was to assess the way complete UCL ruptures are managed in the UK.

Methods: We carried out a multicentre, survey-based cross-sectional study in 37 UK centres over a 16-month period from June 2022 to September 2023. The survey results were analyzed descriptively.

Results: A total of 37 centres participated, of which nine were tertiary referral hand centres and 28 were district general hospitals. There was a total of 112 respondents (69 surgeons and 43 hand therapists). The strongest influence on the decision to offer surgery was the lack of a firm 'endpoint' to stressing the metacarpophalangeal joint (MCPJ) in either full extension or with the MCPJ in 30° of flexion. There was variability in whether additional imaging was used in managing acute UCL injuries, with 46% routinely using additional imaging while 54% did not. The use of a bone anchor was by far the most common surgical option for reconstructing an acute ligament avulsion (97%, n = 67) with a transosseous suture used by 3% (n = 2). The most common duration of immobilization for those managed conservatively was six weeks (58%, n = 65) and four weeks (30%, n = 34). Most surgeons (87%, n = 60) and hand therapists (95%, n = 41) would consider randomizing patients with complete UCL ruptures in a future clinical trial.

Conclusion: The management of complete UCL ruptures in the UK is highly variable in certain areas, and there is a willingness for clinical trials on this subject.

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Conflict of interest statement

B. J. F. Dean and M.Mikhail report a British Society for Surgery of the Hand (BSSH) pump priming grant for this study. B. J. F. Dean also reports a British Medical Association Doris Hillier grant which was unrelated to this study. B. J. F. Dean is also a member of the BSSH research committee. D. J. Beard holds a Senior Investigator grant from the National Institute for Health and Care Research, unrelated to this study. M. Mikhail reports a BSSH grant to the ULCTEAR steering group for this study, allocated under his name. N. Riley reports consulting fees from Acumend, Arthrex, and Meshworks, unrelated to this study.

Figures

Fig. 1
Fig. 1
Chart detailing, by count of surgeon responses, the influence of various factors on the decision to offer surgery.
Fig. 2
Fig. 2
Chart detailing, by count of responses, the estimated percentage of acute complete ulnar collateral ligament (UCL) ruptures operated on.
See this image and copyright information in PMC

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