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Variation In The Rate Of Surgery For Ulnar Collateral Ligament Injury Of The Metacarpophalangeal Joint Of The Thumb
Kyle R Eberlin, MD1; Nicky Stoop, MD1; Teun Teunis, MD1; David Ring, MD, PhD2
1Massachusetts General Hospital, Boston, MA, 2Dell Medical School, Austin, TX
Background: The indications for repair of rupture of the ulnar collateral ligament (UCL) of the metacarpophalangeal (MP) joint of the thumb are debated. We studied factors predictive of operative treatment.
Methods: In this retrospective study we queried the research database from three affiliated urban hospitals in a single city in the United States and identified 383 patients with a thumb MP UCL injury. We recorded age, sex, treating surgeon, and whether or not an MRI was ordered. If radiographs showed a concomitant avulsion fracture we measured fragment size and displacement. Multivariable logistic regression was used to identify factors independently associated with surgery.
Results: Surgery was independently associated with older patient age, widely displaced fractures (2mm), and obtaining an MRI. Two specific surgeons were less likely to operate. Compared to patients without a fracture, fractures without displacement were less likely to have surgery.
Conclusion: The rate of surgery for acute thumb MP UCL injury varies based on patient characteristics and the individual treating surgeon. In addition to gathering better prospective evidence and considering practice guidelines, variation in treatment may decrease with increased patient involvement in decision-making and better accounting for patient preferences. Bivariate analysis of factors associated with surgery for acute ulnar collateral ligament injury of the thumb (n=383).
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