Arthroscopic Reduction and Internal Fixation for Bony Gamekeeper's Thumb

Drs Badia and Riano are from Miami Hand Center, Miami, Fla. Reprint requests: Alejandro Badia, MD, Miami Hand Center, 8905 SW 87th Ave, Ste 100, Miami, FL 33176. Lesion of the ulnar collateral ligament of the thumb is commonly seen in athletes.1 It is usually due to forced radial deviation of the metacarpophalangeal joint causing damage to the structures that provide stability to the ulnar side.2 These injuries may present as avulsion fractures or as tears within the substance of the ligament, or at its insertion point on the proximal phalanx. The most common pattern is an avulsion fracture at the insertion point of the base of the proximal phalanx.3 Stener4 described a model of injury characterized by the interposition of the aponeurosis of the thumb adductor between the distally avulsed ulnar collateral ligament and its insertion into the base of the proximal phalanx. The Stener lesion is an operative indication for the anatomic reasons described, as is a displaced bony avulsion connected to the collateral ligament. Several nonoperative and surgical solutions have been proposed for this problem.5-13 Metacarpophalangeal arthroscopy literature is limited and is commonly related to synovectomy for diseases such as rheumatoid arthritis and hemachromatosis.14-18 One report focuses on the treatment of thumb metacarpophalangeal ulnar collateral ligament tears.10 We feel that the clinical usefulness of arthroscopy is best suited for avulsion fractures since the minimally invasive technique allows for derotation of the fragment and a more anatomic reduction. This article reports our experience with arthroscopic treatment of bony gamekeeper’s thumb.