complications after ucl repair of thumbspring baking championship jordan

Wolters Kluwer Health, Inc. and/or its subsidiaries. Metacarpophalangeal joint fusion was performed on 36.3% (4/11) of patients with RCL (N=1) and UCL (N=3) tears. The purpose of this study is to examine the prevalence and type of ulnar nerve complications after UCLR of the elbow based on the entirety of previously published outcomes in the English literature. Patients who fail nonoperative management have persistent thumb pain, decreased pinch strength, decreased grip strength, limited activities of daily living (especially opening jars and turning keys), continued instability, and early arthrosis.15,39 It is not entirely clear why patients fail nonoperative treatment, but some authors contend that failure may be because of irreducible displacement of the ruptured ligament.15 In patients who had failed nonoperative treatment, who were subsequently taken to surgery, it was found that many of the small avulsion fractures had rotated with the fragment's articular surface rotated out of the plane, precluding fracture healing.15. Please enable scripts and reload this page. There were 6 studies that reported clinical outcomes after autograft UCL reconstruction.11,18,19,21,22,27 Reconstruction techniques (Table 5) and grafts included palmaris longus via bone tunnels with or without K-wire MP joint fixation, palmaris longus with suture anchor fixation, iliac crest boneperiosteumbone graft with cortical screw fixation, and extensor carpi radialis longus bonetendon ligamentoplasty with titanium screw and suture anchor fixation. There is currently no consensus on treatment of acute or chronic UCL injuries. Upper extremity injuries in snow skiers. Results You will be limited for the first 6 weeks with pain, weakness, and stiffness in the hand and thumb. There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. Bone-periosteum-bone graft reconstruction for chronic ulnar instability of the metacarpophalangeal joint of the thumbminimum 5-year follow-up evaluation. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. 37. Eventually this abnormal movement will wear out the joint and it will become arthritic. 1996;25:474477. Acute UCL repair and autograft UCL reconstruction for chronic injury led to excellent clinical outcomes, without a significant difference between the 2 groups. Other than 1 postoperative palmaris longus graft rupture requiring MP joint arthrodesis, no significant complications such as neurovascular injury or superficial or deep infection occurred. This review has demonstrated excellent clinical outcomes after surgical treatment of both acute and chronic UCL injury, without any significant difference between repair and reconstruction for acute and chronic injury, respectively. 12. It is an often-encountered injury and can lead to chronic pain and instability when diagnosed incorrectly. Wolters Kluwer Health Performance Orthopaedics and Sports Medicine, Wilmington, Ohio. 2009;34:304308. Superficial infections tend to settle quickly with oral antibiotics and regular dressings. 1. 1989;17:751753. There were considerable differences in the outcomes collected within the studies and between studies, which precluded the performance of a meta-analysis. Careers. ||Injury chronicity not always defined, but we used ,3 weeks for acute injury and .3 weeks for chronic injury. All but 2 studies were level IV evidence (there was one level II prospective cohort19 and one level III evidence retrospective comparative study20). Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. You may be trying to access this site from a secured browser on the server. A score of 0 was assigned if the item was either omitted or not performed. Would you like email updates of new search results? Infection is a rare complication of hand surgery. Thumb ulnar collateral ligament (UCL) tears occur commonly in elite athletes. This systematic review has demonstrated excellent clinical outcomes (pain, strength, motion, and stability) after surgical treatment (repair and autograft reconstruction) of both acute and chronic UCL injury, without any significant difference between repair and reconstruction for acute and chronic injury, respectively. Surgical treatment has been advocated for all avulsion fractures of the UCL, as the area of articular cartilage is always greater than the fragment size. 2006;31:6875. Epub 2013 Nov 12. Weakened grip or reduced thumb range of motion may occur. Superficial infections are common (5%) after hand surgery and cause redness, swelling, pain and pus around the stitches. Data collected on each patient included patient demographics, imaging (x-rays and MRI), perioperative data (e.g. RESULTS The mean follow-up time was 22.2 months (range 6-54 months). Bookshelf Bailie DS, Benson LS, Marymont JV. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. 1976;58:106112. Epub 2014 Oct 22. 2009;6:e1000097. Bethesda, MD 20894, Web Policies Reconstruction of the collateral ligaments using the extensor pollicis brevis tendon. While ulnar collateral ligament reconstruction (UCLR) of the elbow is an increasingly commonly performed procedure with excellent results reported in the published literature, less attention has been paid to specifically on the characterization of postoperative ulnar nerve complications, and it is unclear what operative strategies may influence the likelihood of these complications. Please confirm that you would like to log out of Medscape. Does Weightlifting Improve Cardiovascular Mortality Risk for Older Aged Adults? 3. This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. Only prospective studies can determine this injury course. Table 1. CMC joint is a saddle-shaped joint composed of the trapezium and the base of the thumb (1st) metacarpal. Subject, surgical, and study data were compared using 2-sample and 2-proportion Z-test calculators with alpha 0.05 because of the difference in sample sizes between the compared groups. and transmitted securely. modify the keyword list to augment your search. Van Dommelen BA, Zvirbulis RA. Accessibility A Bennet fracture is an intra-articular fracture of the 1st metacarpal fracture caused by an axial force applied to the thumb in flexion, that requires surgical fixation when displaced. Key, pulp, and tip pinch and grip strength were either equivalent or only mildly weak compared with the contralateral thumb and hand in all subjects. The diagnosis is best established clinically, though MRI is the imaging modality of choice. Here's Advice, Emergency Birth on a Plane: Two Doctors Earn Their Wings, Brachial Plexus Injury in Sports Medicine, Cervical Spine Acute Bony Injuries in Sports Medicine. The overall complication rate was 13.8% (11/80). [32] The most common region of rupture of the UCL is at the distal insertion or in the distal aspect of the ligament, leaving the proximal stump intact. Fourteen articles were included and analyzed (293 thumbs). Sports Health. Exercises: Progress to Phase II throwing (once successfully completed Phase I) POST-OPERATIVE WEEK 30-32 . The .gov means its official. 6, 9-14 For high-demand overhead athletes, surgical management is often recommended . important to begin moving your fingers right after surgery and keep them moving to avoid stiffness. Complications, failures, and reoperations are rare after surgical treatment of UCL injury. abductor pollicis longus (PIN) proximal, dorsal, and radial force on the shaft fragment. 2000;16:345357. Katolik LI, Friedrich J, Trumble TE, et al.. Repair of acute. Epub 2015 Sep 22. [38] Chuter et al[40] contend that surgical repair of acute UCL ruptures is the gold standard of treatment in the presence of gross instability, Stener lesions, or displaced avulsion fractures. This systematic review has demonstrated excellent clinical outcomes (pain, strength, motion, and stability) after surgical treatment (repair and autograft reconstruction) of both acute and chronic UCL injury, without any significant difference between repair and reconstruction for acute and chronic injury, respectively. In these patients, after failure of nonoperative treatment at anywhere from 1 month to more than 6 years, nearly all patients can achieve complete pain relief, normal pinch and grip strength, joint stability, and range of motion after surgical reconstruction. Any hard force on the thumb that pulls the thumb away from the hand (called a valgus force) can cause damage to the ulnar collateral ligaments. After failure of nonoperative treatment, at anywhere from 6 months to more than 6 years, nearly all patients can achieve complete pain relief, normal pinch and grip strength, joint stability, and range of motion after surgical reconstruction. Educate the patient on anti edema management. A secondary purpose was to compare graft choice and surgical technique for reconstruction. 6. Surgery has been recommended for fracture displacement, significant articular involvement, clinical instability, or fragment rotation.38 Chuter et al40 contend that surgical repair of acute UCL ruptures is the gold standard of treatment in the presence of gross instability, Stener lesions, or displaced avulsion fractures. Looney AM, Fackler NP, Pianka MA, Bodendorfer BM, Fryar CM, Conroy CM, Israel JE, Wang DX, Ciccotti MG, Chang ES. No study directly compared the different types of graft for UCL reconstruction. Your surgeon is the person best able to help you avoid any serious recovery problems. We sought to address a gap in the literature by comparing thumb metacarpophalangeal (MCP) joint angle measurements and biomechanical strength before complete, acute UCL tear and after . 33. Clinical Journal of Sport Medicine23(4):247-254, July 2013. Abstract. Long-term results of ligament reconstruction. Despite 11 of these patients (34%) remaining symptomatic, 5 remaining clinically unstable, and a 25% (n = 8 patients) nonunion rate, all 32 were satisfied with their clinical outcome (mean, 3 years follow-up). Figure 46-1 Muscle-splitting incision through fascia to expose the ulnar collateral ligament. 14 It is important to diagnose complete tears early because . Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures. The thumb joint may feel loose and unstable, making it difficult to grasp objects between the thumb and index finger. *Glickel grading system. By nature of the definition of chronic UCL deficiency, patients with remote UCL injury have either been untreated or have failed prior nonoperative treatment (for various reasons such as pain, weakness, or instability) and gone on to necessitate surgical intervention. The following clinical outcome parameters were extracted, if available, from each article identified for further review and scrutinized: pain, range of motion, key-pinch strength, stability testing, number of retears, range of motion posttreatment, prekey-pinch strength and postkey-pinch strength, and complications. The triangular fibrocartilage complex (TFCC) is an important stabilizer of the distal radioulnar joint (DRUJ). eCollection 2021 Oct. Rashidi A, Haj-Mirzaian A, Dalili D, Fritz B, Fritz J. Eur Radiol. Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. I wore a custom plastic splint that immobilized the MCP joint but allowed me to move the IP joint for 8 weeks total. Leland DP, Pareek A, Therrien E, Wilbur RR, Stuart MJ, Krych AJ, Levy BA, Camp CL. 2016 Mar;44(3):723-8. doi: 10.1177/0363546515621756. Chir Main. Furthermore, there was no donor site morbidity from autograft harvest sites across all studies. 8. Your surgeon will discuss these options with you. It is the result of repetitive stretching and abduction stresses of the ulnar collateral . 1,5,9,10 In acute cases of complete tears involving high-level . Thumb sidedness reported in 3 studies (51 thumbs). If your bone is broken, a pin will be used to put it in place. SAGE Open Med. Figure 46-2 Approach to the ulnar collateral ligament. There were 200 acute injuries and 93 chronic injuries. 2021 Jan;49(1):236-248. doi: 10.1177/0363546520921160. An example of the search strategy used for PubMed was ((((((ulnar[Title/Abstract]) AND collateral[Title/Abstract]) AND ligament[Title/Abstract])) OR ucl[Title/Abstract])) AND thumb[Title/Abstract]. Each abstract was manually reviewed, with potentially relevant full text of studies scrutinized for study inclusion or exclusion. Clipboard, Search History, and several other advanced features are temporarily unavailable. There are some cases where the fusion is not successful and you will still have pain in . It runs from the outer humerus, around the radial head and attaches to the ulna. Basic knowledge of the anatomy of the finger and a thorough evaluation of the patient can ensure proper diagnosis and treatment. Subject demographics are reported in Table 2. Search terms included thumb, ulna(r), collateral, ligament, UCL, repair, reconstruction, and treatment. 19. MCP fusion was performed on 36.3% (4/11) of patients with RCL (N=1) and UCL (N=3) tears. Some broken bones do not heal even when they get the best surgical or nonsurgical treatment. J Bone Joint Surg Am. No significant difference in the outcome was demonstrated between different types of autograft used for UCL reconstruction. Landsman JC, Seitz WH Jr, Froimson AI, et al.. Splint immobilization of gamekeeper's thumb. You may also begin strengthening exercises if needed. abduction-adduction motion. All but 2 were level IV evidence. PMC Bethesda, MD 20894, Web Policies The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. In addition, basic science, anatomical/histopathological, imaging, biomechanical, surgical technique, and studies on digits other than the thumb were excluded. 38. Morphometric Evaluation of Collateral Ligaments of the First Metacarpophalangeal Joint. Meta-analysis of the pooled data was completed. If the tear is diagnosed early a repair will be possible. Thirty-two thumbs were treated nonoperatively and 261 operatively. NR, not reported. three muscles provide deforming forces at the base of the thumb. 44. Methodological quality of the study was assessed using the Quality Appraisal Tool (Table 1). There is currently no consensus on treatment of acute or chronic UCL injuries. The fixation technique associated with the highest rate of neuropathy was the modified Jobe (16.9%) versus DANE TJ (9.1%), figure-of-8 (9.0%), interference screw (5.0%), docking technique (3.3%), hybrid suture anchor-bone tunnel (2.9%), and modified docking (2.5%). Various levels of pain, bruising, or edema may present at the site of damage. Rupture of the. Diagnosis of displaced, 43. In these cases, a new graft may be used to perform a second reconstruction. Please enable it to take advantage of the complete set of features! Unable to load your collection due to an error, Unable to load your delegates due to an error. 8600 Rockville Pike Complications after surgical treatment of UCL injury are rare. After application of all inclusion and exclusion criteria, 14 studies were identified for further analysis and review. It was hypothesized that no difference exists between different types of grafts used for thumb UCL reconstruction. Modified Jobe Versus Docking Technique for Elbow Ulnar Collateral Ligament Reconstruction: A Systematic Review and Meta-analysis of Clinical Outcomes. Unauthorized use of these marks is strictly prohibited. National Library of Medicine Glickel SZ, Malerich M, Pearce SM, et al.. Ligament replacement for chronic instability of the, 28. Orthop J Sports Med. doi: 10.1016/j.asmr.2020.12.004. Hand Clin. Please use this form to submit your questions or comments on how to make this article more useful to clinicians. There is also significant performance bias, as there are multiple different methods of treatment, providers, graft, suture, and fixation types, as well as methods and duration of immobilization. Among cases with concomitant transposition performed, submuscular transposition resulted in a higher rate of reoperation for ulnar neuropathy (12.7%) compared with subcutaneous transposition (0.0%). Kaplan EB. *The Ohio State University Hand and Upper Extremity Center, Columbus, Ohio; Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois; and. Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures. To address the purposes of this systematic review, the authors conducted a search of the following medical databases: PubMed, SPORTDiscus, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Cochrane Central Register of Controlled Trials. Ulnar Collateral Ligament Reconstruction: Anatomy, Indications, Techniques, and Outcomes. Corresponding Author: Hisham M. Awan, MD, The Ohio State University Hand and Upper Extremity Center, 915 Olentangy River Rd, Suite 3200, Columbus, OH 43212 ([emailprotected]). eCollection 2021. The mean patient age was 37.8 years (14.0-78.1). This article provides a review of . Pearl: ensure slight adduction of thumb when placing the thumb spica splint for skier's thumb to reduce stress on the UCL. *Glickel grading scale. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. 1961;43-A:541546. Gamekeeper's thumb: a quantitative evaluation of acute surgical repair. Wilk KE, Arrigo CA, Dugas JR, Cain EL, Andrews JR. 8600 Rockville Pike In a recent study, 49% of UCL disruptions of the thumb were caused by a fall onto an outstretched hand. Re-rupture occurred in 1 patient, chronic subluxation occurred in 1 patient, and chronic pain/stiffness occurred in 5 patients. Range of motion returns much sooner, too. Sakellarides HT, DeWeese JW. Epub 2019 Mar 21. Metacarpophalangeal joint motion ranged from 79% to 100% compared with the contralateral thumb. MCP fusion was performed . Meta-analysis of the pooled data was completed. Comparison of Outcomes Based on Graft Type and Tunnel Configuration for Primary Ulnar Collateral Ligament Reconstruction in Professional Baseball Pitchers. the thumb. 2021 Nov 23;9(11):23259671211055428. doi: 10.1177/23259671211055428. This systematic review has demonstrated excellent clinical outcomes (pain, strength, motion, and stability) after surgical treatment (repair and autograft reconstruction) of both acute and chronic UCL injury, without any significant difference between repair and reconstruction for acute and chronic injury, respectively. MeSH History. Am J Sports Med. It usually occurs secondary to chronic metacarpophalangeal instability and degenerative osteoarthritis of the thumb. J Bone Joint Surg Am. Louis DS, Huebner JJ Jr, Hankin FM. and twist using your thumb. Pichora DR, McMurtry RY, Bell MJ. Complications after surgery were rare. Careers. Mean Quality Appraisal Tool score was 13.1 (55% overall rating study methodological quality). Bostock S, Morris MA. Surgical Repair of Ulnar Collateral Ligament of ThumbDr. doi: 10.1097/JSA.0000000000000322. Therefore, the purpose of this systematic review is to combine patient outcomes from multiple unique studies and analyze the results of treatment of thumb UCL injury to determine the following: The authors hypothesized that no difference exists in clinical outcomes between repair and reconstruction for acute UCL injury. Am J Sports Med. The goal of Fusion Arthroplasty of the CMC joint is to fuse the bones together in the thumb so that they do not rub on each other and cause pain. 15. Fusetti C, Papaloizos M, Meyer H, et al.. All but 2 were level IV evidence. #Injury location reported only in 3 studies. Thus, the latter group of patients (n = 93) was reported separately as chronically UCL-deficient operatively treated subjects' outcomes (Table 3) with attempted prior nonoperative treatment. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. The authors report no funding or conflicts of interest. 2015 Nov-Dec;7(6):511-7. doi: 10.1177/1941738115607208. This was a retrospective study of all patients seen and treated for thumb injuries at a single institution from January 1, 2015, to December 31, 2019, undergoing RCL or UCL repair (CPT code 26540). For more information, please refer to our Privacy Policy. 2012 Nov 7;94(21):2005-12. doi: 10.2106/JBJS.K.01024. Your message has been successfully sent to your colleague. Keyword Highlighting Transfer bias was present in the difference of length of follow-up, despite a minimum of 2 years, and the proportion of subjects who enrolled and completed that which was actually followed up. This injury can have many names such as "skiers thumb", "gamekeepers thumb", and "break dancers thumb.". According to the Glickel grading system, 51 excellent (80%) (joint stability not significantly different from unoperated thumb, less than 15% MP joint motion loss, no pain, no ADL limitations, and less than 15% loss of pinch strength), 11 good (17%), and 2 fair (3%) outcomes were observed. A secondary purpose was to compare graft choice and surgical technique for reconstruction. 11. Return-to-Play Rates and Clinical Outcomes of Baseball Players After Concomitant Ulnar Collateral Ligament Reconstruction and Selective Ulnar Nerve Transposition. Conclusions: MeSH gamekeeper's thumb; skier's thumb; stener lesion; ulnar collateral ligament, NOW OVER 19K FOLLOWERS ON TWITTER. Continuous variable data were reported as mean SDs from the mean. This injury happens when an ulnar collateral ligament (UCL) tough and flexible tissue that connect bones in the thumb gets stretched too far or tears. Orthop Clin North Am. Posner MA, Retaillaud JL. flexion-extension motion. Accessibility 45. Additional Information: After surgery, you should expect some pain, swelling, and stiffness. Neurological Complications Following Arthroscopic and Related Sports Surgery: Prevention, Work-up, and Treatment. An official website of the United States government. Please try after some time. sharing sensitive information, make sure youre on a federal This ligament prevents the thumb from pointing too far away from the hand. He too had the internal brace augmentation. You may search for similar articles that contain these same keywords or you may Mean subject age was 33.9 years. UCL injuries occur via thumb MCP hyperabduction or hyperextension ; in contrast, RCL injuries result from a forced or sudden thumb MCP adduction moment. 1989;14:567573. These tears often occur as a result of a radially directed force on an extended thumb. Clin J Sport Med. Samora, Julie Balch MD, PhD*; Harris, Joshua D. MD; Griesser, Michael J. MD; Ruff, Michael E. MD*; Awan, Hisham M. MD*. Part II: treatment and complications. Jackson M, McQueen MM. Ulnar collateral ligament (UCL) rupture is often seen in patients practicing sports activities, particularly in ski falls. Delma S, Ozdag Y, Baylor JL, Grandizio LC, Klena JC. Nonoperative treatment of acute UCL injury (with or without a Stener lesion) frequently fails, leading to chronic pain, instability, and weakness, eventually prompting surgical intervention.. Comparison of results after surgical repair of acute and chronic ulnar collateral ligament injury of the thumb. Dr. Holt will talk to you about when it is safe to return to work. Increase in Use of Medial Ulnar Collateral Ligament Repair of the Elbow: A Large Database Analysis. In Memoriam: Healthcare Workers Who Have Died of COVID-19, Time to Return to Running After Tibial Stress Fracture in Female Division I Collegiate Track and Field, Sports Hernias, Adductor Injuries, and Hip Problems Are Linked. Patel SS, Hachadorian M, Gordon A, Nydick J, Garcia M. J Hand Microsurg. Instability of the metacarpophalangeal joint of the thumb. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. J Hand Surg Br. Data sources: SYMPTOMS: The thumb may be swollen, bruised and painful. may email you for journal alerts and information, but is committed 1 An injury to the ulnar collateral ligament occurs when this structure is stretched too far. Injuries to the PIP joint remain swollen for long periods of time. A p-value of 0.05 was considered statistically significant. Hintermann B, Holzach PJ, Schutz M, et al.. Skier's thumbthe significance of bony injuries. [15] In patients who had failed nonoperative treatment, who were subsequently taken to surgery, it was found that many of the small avulsion fractures had rotated with the fragment's articular surface rotated out of the plane, precluding fracture healing.[15]. Your thumb will be immobilized in a splint and should not be moved until follow up. [33,45] When repair is attempted, nonanatomical repositioning of the UCL may contribute to the loss of joint motion.[46]. Julie Balch Samora, MD, PhD; Joshua D. Harris, MD; Michael J. Griesser, MD; Michael E. Ruff, MD; Hisham M. Awan, MD. Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit(s) after surgery, including resolved transient symptoms. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. There was no significant difference in patient-specific and injury-specific parameters (subject age, gender, hand dominance, time to treatment, or length of follow-up) between patients with successful and failed nonsurgical treatment (P > 0.05 for each of the compared independent and dependent variables). No study directly compared nonoperative to operative treatment. Pain Swelling Bruising A weaker pinch or problems grabbing things when you use your thumb If surgery is needed, the ligament is reconnected to the bone. Ritting et al[30] assert that operative management of acute injuries is indicated when the thumb is without an endpoint to valgus stress testing. [41] Abrahamsson et al[42] maintain that a proximally displaced ligament, palpated proximal to the MP joint, is a more specific indication for surgery. Danilkowicz RM, O'Connell RS, Satalich J, O'Donnell JA, Flamant E, Vap AR. Obremskey W, Pappas N, Attallah-Wasif E, et al.. Levels of evidence in Orthopaedic Journals. The injury happens when you fall . After three to four weeks, the joint should heal enough to remove the splint and begin strengthening exercises. A Stener lesion is difficult to diagnose but leads to poor healing and usually indicates operative management. The doctor won't know if the repair is . Stener B. Skeletal injuries associated with rupture of the. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Breek JC, Tan AM, van Thiel TP, et al.. Free tendon grafting to repair the metacarpophalangeal joint of the thumb. Melone CP Jr, Beldner S, Basuk RS. A chi-square test of independence was performed to examine the relation between UCL versus RCL repair and presence of a complication. Physical examination of the thumb demonstrates the instability of the MCP joint, impossibility of opposition of the thumb, and the weakening of gripping force.5,6 The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. [30,43,44] It has been well documented that direct suture techniques fail in chronic injuries. Thus, the true natural history is yet unknown. A systematic review of the literature was completed using the MEDLINE, PubMed, and Ovid databases. When a broken bone fails to heal it is called a "nonunion." A "delayed union" is when a fracture takes longer than usual to heal. Main results: Causes. Throwing status reported in 4 studies. 2015 Apr;46(2):281-92. doi: 10.1016/j.ocl.2014.11.007. Docs Struggle to Keep Up With the Flood of New Medical Knowledge. Evidence-based use of clinical examination, ultrasonography, and MRI for diagnosing ulnar collateral ligament tears of the metacarpophalangeal joint of the thumb: systematic review and meta-analysis. Acute UCL repair and autograft UCL reconstruction for chronic injury led to excellent clinical outcomes, without a significant difference between the 2 groups. An anatomic basis for treatment. 4 weeks after surgery: The splint can be removed for basic hand hygiene and light thumb movements (actives only). Nonoperative treatment of acute UCL injury (with or without a Stener lesion) frequently fails, leading to chronic pain, instability, and weakness, eventually prompting surgical intervention.

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