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Demographics, radiographic characteristics, treatment, and classification of pediatric thumb bony Ulnar Collateral Ligament (UCL) injuries
Journal article   Peer reviewed

Demographics, radiographic characteristics, treatment, and classification of pediatric thumb bony Ulnar Collateral Ligament (UCL) injuries

James S. Lin, Mallory Rowan and Julie Balch Samora
Current orthopaedic practice, Vol.36(4), 1307
07/01/2025
DOI: 10.1097/BCO.0000000000001307

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Abstract

Background: Pediatric thumb ulnar collateral ligament (UCL) injuries usually have osseous involvement presenting as a Salter-Harris III avulsion fracture from the base of the proximal phalanx. There is limited guidance about when surgical or non-surgical treatment is more appropriate. Methods: Patients with thumb bony UCL injuries who presented to a large pediatric hospital between 2007 and 2017 were retrospectively identified. Demographics, fracture pattern, treatment, clinical course, and outcomes were collected. Radiographic measurements included size and displacement of fracture fragment as a percentage of the proximal phalanx base articular surface. A classification system was developed incorporating clinical stability of the metacarpophalangeal joint and quantity of displacement. Results: Sixty-five patients were included (47 males and 18 females). The mean age at time of injury was 14.8 SD 1.9 yrs old. 46 (71%) injuries occurred during sporting activities. 50 (77%) patients underwent nonsurgical management with immobilization, and 15 (23%) patients were treated surgically with open reduction internal fixation. For patients treated surgically, the mean fragment size was 28.2% SD 6.8% of the articular surface compared to 14.3% SD 12.5% of those treated non-surgically (P<0.0001). The mean fracture displacement for surgically treated patients was 32.7% SD 19.0% compared to 11.4% SD 7.3% of those treated non-surgically (P<0.0001). Overall, 100% of patients reported they were able to return to their previous level of activity. Conclusion: Many pediatric thumb bony UCL injuries can be treated non-surgically. A classification system based upon joint stability and fracture displacement may help guide appropriate management of these injuries.
 Life Sciences & Biomedicine Orthopedics Science & Technology

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