J Korean Orthop Assoc.  2008 Feb;43(1):112-117. 10.4055/jkoa.2008.43.1.112.

Ligament Reconstruction for the Posttraumatic Instability of the Carpometacarpal Joint of the Thumb: A Report of Three Cases

Affiliations
  • 1Department of Orthopaedic Surgery, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea. jacobass@hallym.or.kr
  • 2Department of Orthopaedics, Yonsei University Wonju College of Medicine, Wonju, Korea.

Abstract

Eaton and Littler's ligament reconstruction is used to treat carpometacarpal instability of the thumb using the flexor carpi radialis tendon. This procedure involves a reconstruction of the deep anterior oblique ligament in patients with post-traumatic prearthritic unstable joints. According to a recent paper, the dorsoradial ligament as well as the deep anterior oblique ligament plays an important role in stabilizing the trapeziometacarpal joint. We report three cases of post-traumatic instability in a prearthritic thumb that was treated with Eaton and Littler's reconstruction using the flexor carpi radialis tendon.

Keyword

Thumb; Deep anterior oblique ligament; Dorsoradial ligament; Instability; Ligament reconstruction

MeSH Terms

Carpometacarpal Joints
Humans
Joints
Ligaments
Tendons
Thumb

Figure

  • Fig. 1 (A) Radiograph showing the post-traumatic deformity at the thumb metacarpal base and subluxated trapeziometacarpal joint. (B) Ligament reconstruction and corrective osteotomy were performed. (C) Radiograph of the thumb carpometacarpal joints at 4 months. (D) Photographs of the hand at 26 months after surgery.

  • Fig. 2 (A) Photograph of left hand shows a protruded thumb carpometacarpal joint. Radiograph shows an almost dislocated trapeziometacarpal joint. (B) A ligament reconstruction and corrective osteotomy were performed. (C) Radiograph of the thumb carpometacarpal joints at 6 months. (D) Photograph of the hand at 25 months after surgery.

  • Fig. 3 (A) Photograph of the left hand shows a protruded thumb carpometacarpal joint. Radiograph shows an almost dislocated trapeziometacarpal joint. (B) A ligament reconstruction was performed. The thumb spica splint was applied. (C) Radiographs of the thumb carpometacarpal joints at 6 months. (D) Photograph of the hand at 23 months after surgery.

  • Fig. 4 Schematic diagram of the ligamentous anatomy of the trapeziometacarpal joint. Dorsoradial and deep anterior oblique ligament (dAOL) play the most significant role in stabilizing the trapeziometacarpal joint.

  • Fig. 5 (A) Diagram of the Eaton-Littler ligament reconstruction. Half of the flexor carpi radialis (FCR) was passed through a bony channel in the metacarpal base. The course of the tendon strip reinforces in the volar, dorsal, and radial aspect of the joint. (B) Ideal direction of the bony channel, which helps in the function of the dorsoradial ligament more effectively is shown.


Reference

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