Release notes of Thumb

The content has been revised by Rémy Liechti (CH) with Simon Lambert (UK) as executive editor and Inese Breide (LV) as reviewer.

The main differences to the first edition are:

• Management of CMC and MCP joint dislocation
• Procedures updated with VA locking plates
• Distal phalangeal content adjusted to the thumb

Pages on the following topics have been added:

• Diaphyseal and distal articular fractures of the metacarpal and their management
• Dorsal approach to the proximal phalanx and palmar approach to the IP joint
• Patient assessment and positioning
• Bone graft addition
• Postoperative treatment
• Complications and technical failures

The following videos have been added:

• Thumb—Trapeziometacarpal joint—Radiopalmar approach
• Thumb—1st metacarpal—Dorsal approach
• Thumb—Interphalangeal joint—Dorsal approach
• Thumb—Metacarpophalangeal joint—Dorsal approach
• Metacarpal and Phalanx—Fractures and Soft-tissue Injuries—Thumb Spica
• Thumb, head of the proximal phalanx—Unicondylar fracture—Fracture fixation using 2.0 mm Lag Screw
• Metacarpal I, base—Bennett fracture—Fixation with 2.0 mm lag screws
• Metacarpal I, Base—Rolando Fracture—Plate Fixation Using Various Types of Treatment

The thumb material, second edition, includes a detailed description of the following injury types and their management.

Dislocation of the CMC joint:

• Nonoperative treatment
• K-wire fixation

Extraarticular fracture of the proximal end segment (Winterstein):

• Nonoperative treatment
• K-wire fixation
• Plate fixation

Partial articular fracture of the proximal end segment (Bennett):

• Closed reduction – Splinting
• K-wire fixation
• Screw fixation

Complete articular fracture of the proximal end segment (Rolando):

• Nonoperative treatment
• K-wire fixation
• Plate fixation

Simple oblique fracture of the diaphysis and extraarticular distal end segment:

• Closed reduction – Splinting
• Lag-screw fixation
• Lag-screw fixation with a neutralization plate
• Plate fixation with metaphyseal support screws
• Compression plating

Simple transverse fracture of the diaphysis and extraarticular distal end segment:

• Closed reduction – Splinting
• K-wire fixation
• Intramedullary K-wire fixation
• Intramedullary screw fixation
• Plate fixation with metaphyseal support screws
• Compression plating

Multifragmentary fracture of the diaphysis and extraarticular distal end segment:

• Nonoperative treatment
• External fixation
• Plate fixation with metaphyseal support screws
• Bridge plating

Articular fracture of the distal end segment:

• Nonoperative treatment
• Lag-screw fixation of a partial articular fracture
• Screw fixation of a complete articular fracture
• Plate fixation with metaphyseal support screws
• Plate fixation of a complete articular fracture

Dislocation of the MCP joint:

• Reduction with or without joint transfixation

Avulsion at the proximal end segment (skier’s/gamekeeper’s thumb):

• Nonoperative treatment
• Collateral ligament reattachment
• Screw fixation

Partial articular fracture of the proximal end segment:

• Screw fixation

Complete articular fracture of the proximal end segment (incl pilon fractures):

• Open reduction - internal fixation (ORIF)

Simple oblique extraarticular and diaphyseal fracture:

• Nonoperative treatment
• Lag-screw fixation
• Lag-screw fixation with a neutralization plate
• Plate fixation with metaphyseal support screws

Simple transverse extraarticular and diaphyseal fracture:

• Closed reduction – Splinting
• Intramedullary screw fixation
• Plate fixation with metaphyseal support screws
• Compression plating

Multifragmentary extraarticular and diaphyseal fracture:

• Nonoperative treatment
• Plate fixation with metaphyseal support screws
• Bridge plating

Partial articular fracture of the distal end segment:

• Nonoperative treatment
• Lag-screw fixation
• Plate fixation with metaphyseal support screws

Complete articular fracture of the distal end segment:

• Nonoperative treatment
• Screw fixation
• Plate fixation

Dislocation of the interphalangeal joint:

• Nonoperative treatment
• Joint transfixation with K-wire
• Collateral ligament repair

• Suture fixation of extensor tendon
• Suture fixation of flexor tendon

Dorsal avulsion injury of the proximal end segment (mallet injury):

• Nonoperative treatment
• Extensor block pinning or K-wire fixation (with joint transfixation)
• Suture fixation
• Screw fixation

Palmar avulsion injury of the proximal end segment:

• Nonoperative treatment
• Suture fixation
• Screw fixation

Complete articular fracture of the proximal end segment:

• Nonoperative treatment
• Surgical treatment

Simple fracture of the diaphysis and distal end segment:

• Nonoperative treatment
• K-wire fixation
• Cannulated screw fixation

Multifragmentary fracture of the diaphysis and distal end segment:

• Nonoperative treatment
• K-wire fixation

Approaches:

• Dorsal approach to the IP joint
• Dorsal approach to the MCP joint
• Dorsal approach to the metacarpal
• Dorsoulnar approach to the MCP joint
• Radiopalmar approach to the metacarpal base
• Dorsal approach to the proximal phalanx
• Palmar approach to the IP joint

Preparation:

• Supine patient position

Further reading:

• Patient assessment
• Bone graft addition
• Postoperative treatment
• Complications and technical failures

The content has been created by Matej Kastelec (SI), Renato Fricker (CH), Fiesky Nuñez (VE), and Terry Axelrod (CA) with Chris Colton (UK) as executive editor.

The thumb material, first edition, included a detailed description of the following injury types and their management.

Base:

• External fixation
• Locking compression plate (LCP) fixation

Bennett fracture:

• Nonoperative treatment
• K-wire fixation
• Lag screw fixation

Rolando fracture:

• Nonoperative treatment
• Plate fixation

Skier’s thumb:

• Ligament reattachment with suture anchors

Pilon fractures:

• Open reduction, internal fixation (ORIF)

Multifragmentary:

• Bridge plate fixation

Transverse:

• Minicondylar compression plate fixation

Oblique:

• Nonoperative treatment
• Lag screw fixation
• Lag screw with protection plate
• Minicondylar plate with lag screw

Multifragmentary:

• Nonoperative treatment
• Minicondylar bridge plate fixation

Oblique:

• Nonoperative treatment
• Lag screw fixation

Unicondylar fracture with dislocation:

• Lag screw fixation

Bicondylar:

• Lag screw fixation

Dislocation:

• Nonoperative treatment
• K-wire fixation

Dorsal avulsion:

• Nonoperative treatment
• K-wire immobilization
• Lag screw fixation
• Cerclage compression wire
• K-wire fixation

Palmar avulsion:

• Nonoperative treatment
• K-wire fixation
• Suture fixation
• Lag screw fixation

Transverse:

• Nonoperative treatment
• K-wire fixation

Multifragmentary:

• Nonoperative treatment
• K-wire fixation

Approaches:

• Dorsal approach to the IP joint of the thumb
• Dorsal approach to the MCP joint of the thumb
• Dorsal approach to the thumb metacarpal
• Dorsoulnar approach to the MCP joint of the thumb
• Radiopalmar approach to the base of the thumb

Further reading:

• References