Miniature Donkeys For Sale Yorkshire, Karen Wheaton Ministries 2020, What Language Does The World Serpent Speak, Driving After Meniscus Root Repair, Who Plays Matt Casey's Sister On Chicago Fire, Articles C

10. The outcome of elbow ulnar collateral ligament reconstruction in overhead athletes: a systematic review. Ryu J, Fagan R. Arthroscopic treatment of acute complete thumb metacarpophalangeal. It usually occurs secondary to chronic metacarpophalangeal instability and degenerative osteoarthritis of the thumb. Hand Injuries - Finger Tip Injuries, Jersey Finger, PIP Dislocations The mean patient age was 37.8 years (14.0-78.1). This ligament prevents the thumb from pointing too far away from the hand. 1995;18:11611165. Proximal interphalangeal joint injuries of the hand. Data sources: Meta-analysis of the pooled data was completed. Gamekeeper's thumb: a quantitative evaluation of acute surgical repair. Bostock S, Morris MA. This tool is a 12-item instrument, with each item possibly receiving a minimum integer of 0 and a maximum integer of 2 score points. Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. Chir Main. All but 2 studies were level IV evidence (there was one level II prospective cohort19 and one level III evidence retrospective comparative study20). [19] Although most surgical undertakings result in good clinical and functional outcomes, there are postoperative complications, including stiffness and decreased range of motion (specifically, restricted flexion at the MP joint), failed reconstruction, infection, neuropraxia, continued pain, implant failure, graft failure, loosening, scarring, and arthrosis. Mechanism of injury to the UCL of the MCP joint of the thumb is sudden, forced, radial deviation (abduction) and extension resulting in partial or complete tear of the ligament. 1994;25:2123. Clipboard, Search History, and several other advanced features are temporarily unavailable. 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. Symptoms of the UCL injury include pain, instability of the MCP joint of the thumb, and weakness in prehension and the chronicity of the injury. The grip strength and the pinch strength were 94.3% and 92.27%,. PMC Figure 46-2 Approach to the ulnar collateral ligament. J Bone Joint Surg Am. Please try again soon. 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. Re-rupture occurred in 1 patient, chronic subluxation occurred in 1 patient, and chronic pain/stiffness occurred in 5 patients. Treatment of chronic injuries of the. Part II: treatment and complications. 17. Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. Through a small incision along the side of the thumb joint, we will see where the ligament was torn. All but 2 were level IV evidence. Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. Alejandro Badia Orthopedic Hand Surgeon Hands, Elbow, Shoulder and Wrist - Badia Hand to Shoulder Ce. A sprained thumb is a common injury among athletes. Mean study follow-up was 42.8 months. *Gender reported in 12 studies (218 subjects). If your bone is broken, a pin will be used to put it in place. 2015 Apr;46(2):281-92. doi: 10.1016/j.ocl.2014.11.007. There are many ways to manage both acute and chronic thumb UCL deficiency, and controversy persists as to the best treatment options. An official website of the United States government. Skier's thumb is a partial or complete rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. Search terms included thumb, ulna(r), collateral, ligament, UCL, repair, reconstruction, and treatment. Conclusions: The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Outcomes and Return to Sport after Ulnar Collateral ligament reconstruction in adolescent baseball players. 7. J Hand Surg Glob Online. The LUCL is located on the lateral or outside part of the elbow. Leland DP, Pareek A, Therrien E, Wilbur RR, Stuart MJ, Krych AJ, Levy BA, Camp CL. eCollection 2021. UCLR case series that contained complications data were included. However, thumb UCL reconstruction was hypothesized to be significantly better than repair for chronic UCL injury. Tommy John surgery; ulnar collateral ligament reconstruction; ulnar nerve transposition; ulnar neuropathy. Van Dommelen BA, Zvirbulis RA. 45. Conclusion: Eighty patients were included in the study [N=62 (UCL), N=18 (RCL)]. UCLR techniques associated with the highest rates of neuropathy were detachment of the FPM, modified Jobe fixation, and concomitant ulnar nerve transposition, although it remains unclear whether there is a causal relationship between these factors and subsequent development of postoperative ulnar neuropathy due to limitations in the current body of published literature. Would you like email updates of new search results? SAGE Open Med. sharing sensitive information, make sure youre on a federal three muscles provide deforming forces at the base of the thumb. There were 200 acute injuries and 93 chronic injuries. Stener B. Skeletal injuries associated with rupture of the. Superficial infections are common (5%) after hand surgery and cause redness, swelling, pain and pus around the stitches. Mean Quality Appraisal Tool score was 13.1 (55% overall rating study methodological quality). 1,6,15 The mechanism of injury is a radially directed force on an extended thumb, which can occur when an athlete falls onto an abducted thumb, slides into a baseball base, or attempts to catch a ball. Danilkowicz RM, O'Connell RS, Satalich J, O'Donnell JA, Flamant E, Vap AR. [6] Treatment [ edit] A post-operative photo of repair of a complete rupture of the ulnar collateral ligament. If you experience a high temperature, excess bleeding, swelling or pain, contact your surgeon. Traumatic Finger Injuries: What the Orthopedic Surgeon - RadioGraphics The original study using this tool had a mean quality score range of 25% to 96% but had more than half of the studies scoring >75%.16 Despite these study limitations, this systematic review is strong in that it analyzes the largest number of studies and subjects in the literature managed with both nonoperative and operative means for acute and chronic UCL injury. Complications, failures, and reoperations are rare after surgical treatment of UCL injury. 39. The ulnar collateral ligament (UCL) of the thumb is commonly injured by falling onto an outstretched hand or in sports where the thumb metacarpal phalangeal joint (MP) is hyperextended or hyper-abducted. Surgical management of chronic, 42. Abstract. Keyword Highlighting ECRL, extensor carpi radialis longus; IP, interphalangeal; MRI, magnetic resonance imaging; NR, not reported. Epub 2013 Nov 12. Rehabilitation and Return-to-Play Criteria Following Ulnar Collateral Ligament Reconstruction. Complications Following Distal Radius Fractures - Mike Reinold Acute Finger Injuries: Part I. Tendons and Ligaments | AAFP Complications of Ulnar Collateral Ligament Repair | SpringerLink 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 Some error has occurred while processing your request. 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. Meta-analysis of the pooled data was completed. A Comparison of Acute Versus Chronic Thumb Ulnar Collateral Ligament Surgery Using Primary Suture Anchor Repair and Local Soft Tissue Advancement. After application of all inclusion and exclusion criteria, 14 studies were identified for further analysis and review. Ulnar collateral ligament tear represents 60 percent of upper limb problems in skiers and is frequently overlooked and underdiagnosed. 2005;24:217221. In addition, basic science, anatomical/histopathological, imaging, biomechanical, surgical technique, and studies on digits other than the thumb were excluded. Am J Sports Med. The .gov means its official. Ulnar collateral ligament injury of the thumb - Wikipedia Ulnar collateral ligament (UCL) injuries have significantly increased over the past few decades, especially in young throwing athletes. Delma S, Ozdag Y, Baylor JL, Grandizio LC, Klena JC. The mechanism of UCL injury is a forced abduction or rotation and hyperextension injury of the thumb at the MP joint.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.32 Ulnar collateral ligament injuries can involve injuries to the dorsal capsule, palmar plate, and adductor aponeurosis.33 Avulsion fractures of the ulnar base of the proximal phalanx occur 20% to 30% of the time.17,34 Anywhere from 14% to 64% of UCL injuries have associated Stener lesions, which occur when the adductor aponeurosis is interposed between the ruptured end of the UCL and its site of proximal phalanx attachment.32, Nonsurgical treatment has been advocated for nondisplaced, or minimally displaced avulsion fractures of the UCL either with functional bracing35 or via thumb spica casting or splinting.23,3638 Kuz et al recommend that most acute avulsion fractures of the thumb UCL be treated nonsurgically, with the exception of displaced fractures with more than 30% articular involvement or bony Stener lesions. Table 1. 2009;6:e1000097. to maintaining your privacy and will not share your personal information without 11. A score of 2 was assigned if the item was completely and accurately performed and reported. PIP Joint Injuries of the Finger - Orthogate PDF SKIER'S THUMB LIGAMENT SURGERY - Twin Cities Orthopedics UCL injuries occur via thumb MCP hyperabduction or hyperextension ; in contrast, RCL injuries result from a forced or sudden thumb MCP adduction moment. Thumb sprain may cause bruising, tenderness, and swelling around the base of the thumb. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PDF Ulnar Collateral Ligament Repair of Thumb - Sussex Hand Surgery 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). The major arc of motion of the thumb MP joint is flexion and extension, although there is some abduction, adduction, and rotation. Accurate diagnosis of finger injuries can often be difficult, given the complicated soft-tissue anatomy of the hand and the diverse spectrum of injuries that can occur. There are some cases where the fusion is not successful and you will still have pain in . government site. MeSH 44. Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. The anti edema management will continue for several weeks. Lateral Ulnar Collateral Ligament Reconstruction - The CORE Institute Complications after surgery were rare. No significant difference in the outcome was demonstrated between different types of autograft used for UCL reconstruction. Of the 262 potentially relevant studies, 14 studies were identified for review11,15,1829 (Figure 1). 1994;23:797804. Breek JC, Tan AM, van Thiel TP, et al.. Free tendon grafting to repair the metacarpophalangeal joint of the thumb. UCL repair surgery is a procedure to treat an injury to the UCL, the soft tissue that connects the bones of the thumb and provides stability to the thumb joint. 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. The search was performed on November 17, 2011, using PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines.13 There were no limits placed on study publication date. Posner MA, Retaillaud JL. 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. Clin Orthop Relat Res. This website also contains material copyrighted by 3rd parties. This is a strong ligament that supports the thumb when pinching or gripping and if it is damaged may lead to a chronic instability of the thumb which causes problems with function. Ulnar collateral ligament (UCL) rupture is often seen in patients practicing sports activities, particularly in ski falls. Sports Med Arthrosc Rev. 2021 Apr 15;3(2):e527-e533. Instability of the metacarpophalangeal joint of the thumb. Ritting et al30 assert that operative management of acute injuries is indicated when the thumb is without an endpoint to valgus stress testing. Skier's thumb - Physiopedia This leads to what is know as a positive ulnar variance. Diagnosis of displaced, 43. 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. The injury happens when you fall . Return to Play in Athletes After Thumb Ulnar Collateral Ligament Repair Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures. You may also begin strengthening exercises if needed. A score of 0 was assigned if the item was either omitted or not performed. There is currently no consensus on treatment of acute or chronic UCL injuries. 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. Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. 15. Additional Information: After surgery, you should expect some pain, swelling, and stiffness. Consensus was obtained between the authors on assignment of study quality scores with any score dispute being decided by default assignment of the lower of the 2 disputing scores, as originally reported and recommended in the original study using the Quality Appraisal Tool.16. Various complications have been previously documented including transient and permanent neuropathies involving the ulnar, saphenous, and median palmar nerves, neuroma formation, hematoma, infection, donor site harvest tenderness, postoperative stiffness, retear of flexor-pronator muscle, and stress fracture of the ulnar bone bridge. Part I of this two-part article focuses on common tendon and . Symptoms are dependent on the cause and severity of injury to the UCL. 35. 2. Am J Sports Med. Unauthorized use of these marks is strictly prohibited. Evaluation and management of elbow injuries in the adolescent overhead athlete. FOIA Thorough literature review to define the question, Specific inclusion and exclusion criteria, Appropriate scope of psychometric properties, Sample size calculation and justification, Authors referenced specific procedures for administration, scoring, and interpretation of procedures, Valid conclusions and clinical recommendations, 96% good and excellent outcomes* with stable joint, pain relief, restored strength, and 85% motion retention, 100% good and excellent outcomes,* 85% without pain, 70% without laxity, 82% strength retention, and 79% motion retention, 100% good and excellent outcomes,* 100% without pain or instability, 89% strength retention, and 90% motion retention, 100% stability, 96% key pinch strength retention, and 106% pulp pinch strength retention, 89% without pain, 89% pinch strength retention, 93% grip strength retention, and 74% motion retention, 100% good and excellent outcomes,* 90% strength retention, and 92% motion retention, 100% stability, 100% strength retention, and 100% motion retention, Both returned to previous level of sport and function, Compared intraosseous suture anchor and early mobilization to pullout suture or button and cast immobilization, Both groups significantly improved outcomes, 9 had suture periosteal repair; 1 had pullout suture repair, 31% loss of motion at MP joint; 10% loss of motion at IP joint, Arthroscopic Stener reduction and K-wire MP immobilization, No patient had loss of motion .10 degrees, 8 ligament repairs; 1 anchor; 1 drill hole; 4 K-wire fixations of avulsion, No detectable residual UCL laxity in 10 patients, 2 had less than 15 degrees laxity, 7 pullout suture and K-wire MP immobilization; 25 periosteal soft tissue suture, Palmaris longus via bone tunnels with or without K-wire fixation MP joint, Iliac crest boneperiosteumbone with cortical screw fixation, ECRL bonetendon ligamentoplasty with 1.5-mm titanium screw and suture anchor fixation, Palmaris longus via bone tunnels with K- ire fixation MP joint, 20 excellent, 4 good, and 2 fair results*. The torn thumb ligament is repaired or reconstructed during surgery. Corresponding Author Hisham M. Awan, MD, The Ohio State University Hand and Upper Extremity Center, 915 Olentangy River Rd, Suite 3200, Columbus, OH 43212 (hisham.awan@osumc.edu). The triangular fibrocartilage complex (TFCC) is an important stabilizer of the distal radioulnar joint (DRUJ). You may be trying to access this site from a secured browser on the server. Get new journal Tables of Contents sent right to your email inbox, Outcomes After Injury to the Thumb Ulnar Collateral LigamentA Systematic Review, Articles in PubMed by Julie Balch Samora, MD, PhD, Articles in Google Scholar by Julie Balch Samora, MD, PhD, Other articles in this journal by Julie Balch Samora, MD, PhD, Ulnar Collateral Ligament Injury of the Thumb Metacarpophalangeal Joint, Weight Training in Youth-Growth, Maturation, and Safety: An Evidence-Based Review, Effectiveness of Shockwave Treatment Combined With Eccentric Training for Patellar Tendinopathy: A Double-Blinded Randomized Study, Core Stability Exercises for Low Back Pain in Athletes: A Systematic Review of the Literature, Diagnosis and Treatment of Triceps Tendon Injuries: A Review of the Literature, Privacy Policy (Updated December 15, 2022). This damage may lead to temporary or permanent numbness or weakness. In these cases, a new graft may be used to perform a second reconstruction. All techniques improved clinical outcomes, including pain, motion, strength, and stability. J Bone Joint Surg Am. abductor pollicis longus (PIN) proximal, dorsal, and radial force on the shaft fragment. Before The mean postoperative follow up time was 105.4 days (13-617) and mean time to complication was 71.6 days (13-293). 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. If the tear is diagnosed early a repair will be possible. 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. 2005;87:26322638. Mean subject age was 33.9 years. After the surgery you will lose some mobility in the thumb, but you are still able to grasp objects. [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. The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. Arthrosc Sports Med Rehabil. MCP (MetaCarpophalangeal) Collateral Ligament Sprain Outcomes After Injury to the Thumb Ulnar Collateral Ligament - Medscape The injury involves the ulnar collateral ligament (UCL) of the thumb. When applicable, these parameters were compared, integrated, summated, and statistically analyzed. Study design: J Hand Surg Br. Patient Demographics of Thumb RCL and UCL Injuries. The overall complication rate after primary thumb RCL and UCL repair was 13.8%. There is currently no consensus on treatment of acute or chronic UCL injuries. Erickson BJ, Harris JD, Chalmers PN, Bach BR Jr, Verma NN, Bush-Joseph CA, Romeo AA. The https:// ensures that you are connecting to the Jupiter JB, Sheppard JE. Moher D, Liberati A, Tetzlaff J, et al.. eCollection 2022 Jan. Gnanasekaran D, Raveendranath V, Karupusamy A. J Hand Microsurg. Thumb sidedness reported in 3 studies (51 thumbs). J Bone Joint Surg Am. There is currently no consensus on treatment of acute or chronic UCL injuries. Outcome of avulsion fractures of the ulnar base of the proximal phalanx of the thumb treated nonsurgically. The original study using this tool had a mean quality score range of 25% to 96% but had more than half of the studies scoring >75%. Bethesda, MD 20894, Web Policies The overall complication rate after primary thumb RCL and UCL repair was 13.8%. Eurasian J Med. You will receive email when new content is published. Epub 2021 Jan 18. 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. Bean CH, Tencer AF, Trumble TE. Treatment for thumb collateral ligament injury - KW orthopaedics fall on outstretched hand and abducted thumb ball or racquet strike Symptoms common symptoms pain at ulnar aspect of MCP joint worse with pinch or grasp most common for UCL tear radial-sided MCP pain most common complaint for RCL tear Physical exam inspection rarely visible deformity of joint palpation doi: 10.1016/j.asmr.2020.12.004. 2016 Mar;44(3):723-8. doi: 10.1177/0363546515621756. The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. Purpose. Seventeen articles (n = 1518 cases) met the inclusion criteria, all retrospective cohort studies. 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. doi: 10.1097/JSA.0000000000000322. Roy J, MacDermid J, Woodhouse L. Measuring shoulder function: a systematic review of four questionnaires. Rupture of the ulnar collateral ligament of the thumb - a review Outcomes After Injury to the Thumb Ulnar Collateral Ligament Arnold DM, Cooney WP, Wood MB. NR, not reported. 2020 Apr 28;13(4):228-231. doi: 10.1055/s-0040-1709098. Simmons underwent surgery, also performed by Shin, to repair a torn UCL in his left thumb (like Trout, Simmons injured his non-dominant thumb). Epub 2020 Jun 29. This injury can have many names such as "skiers thumb", "gamekeepers thumb", and "break dancers thumb.". Please confirm that you would like to log out of Medscape. Background: Data is temporarily unavailable. 2019 Apr;47(5):1103-1110. doi: 10.1177/0363546519831705. Any time there is something concerning you, even if it's a slight concern, always call your surgeon right away. eCollection 2021 Apr. 1 Major components of the TFCC are the articular disc (AD), meniscus homolog, radioulnar ligaments, and extensor carpi . The surgeon then reattaches the UCL and uses a suture anchor or screw to hold it . official website and that any information you provide is encrypted Modified Jobe Versus Docking Technique for Elbow Ulnar Collateral Ligament Reconstruction: A Systematic Review and Meta-analysis of Clinical Outcomes. RESULTS The mean follow-up time was 22.2 months (range 6-54 months). 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. Am J Sports Med. I wore a custom plastic splint that immobilized the MCP joint but allowed me to move the IP joint for 8 weeks total. When assessed, most patients returned to their preinjury employment. 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 . The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Performance Orthopaedics and Sports Medicine, Wilmington, Ohio. Surgical Repair of Ulnar Collateral Ligament of ThumbDr. 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. 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. All continuous data for independent and dependent variables were assimilated with weighted means and SDs based on the number of subjects or thumbs and the applicable means and SDs. Am J Sports Med. Am J Sports Med. Whether a difference in clinical outcome exists between operative and nonoperative management of thumb UCL acute injuries; Whether a difference in clinical outcome exists between operative and nonoperative management of thumb UCL chronic injuries; Whether a difference in clinical outcome exists between repair and reconstruction of the thumb UCL for acute (less than 3 weeks) UCL injury; Whether a difference in clinical outcome exists between repair and reconstruction of the thumb UCL for chronic (more than 3 weeks) UCL injury; Whether a difference in clinical outcome after reconstruction of the thumb UCL exists between different choices of graft; Whether a difference in clinical outcome after operative treatment exists between acute and chronic UCL injuries. For example, it can be removed when performing . Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. Rao S, D'Amore T, Willier DP 3rd, Gawel R, Jack RA 2nd, Cohen SB, Ciccotti MG. Orthop J Sports Med. The doctor won't know if the repair is . Julie Balch Samora, MD, PhD; Joshua D. Harris, MD; Michael J. Griesser, MD; Michael E. Ruff, MD; Hisham M. Awan, MD. Hintermann B, Holzach PJ, Schutz M, et al.. Skier's thumbthe significance of bony injuries. The UCL is a band of tough, fibrous tissue that connects the bones at the base of the thumb. After three to four weeks, the joint should heal enough to remove the splint and begin strengthening exercises. 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. Upper extremity injuries in snow skiers. Kato H, Minami A, Takahara M, et al.. Surgical repair of acute collateral ligament injuries in digits with the Mitek bone suture anchor.