MANUAL MINORS
Gamekeeper’s thumb with avulsion fracture is an injury to the ulnar collateral ligament (UCL) of the thumb’s metacarpophalangeal (MCP) joint, caused by excessive abduction force. It occurs when a small bone fragment detaches along with the ligament. This injury is common in skiers and athletes who experience falls with an outstretched hand, placing tension on the thumb ligament.
Diagnosis
Diagnosis involves a history of trauma, typically involving forced hyperextension or abduction of the thumb. Symptoms include pain on the inner side of the thumb, swelling, instability, and difficulty gripping objects. X-rays reveal the detached bone fragment, confirming the avulsion fracture.
Differential Diagnosis
Condition | Key Differences |
|---|---|
Simple thumb sprain | Pain without evidence of bone fracture on X-rays and less instability. |
Bennett fracture | Intra-articular fracture at the base of the first metacarpal without primary UCL involvement. |
Thumb dislocation | Visible joint displacement without associated fracture. |
Rhizarthrosis | Chronic pain, stiffness, and degenerative changes without acute trauma history. |
Emergency Management
Immediate immobilisation of the affected thumb with a splint or cast, keeping the MCP joint in slight flexion and the thumb in adduction.
Ice application to reduce swelling and analgesics to control pain.
Initial X-rays to confirm the avulsion fracture.
Severe instability or significant bone fragment displacement may require orthopaedic reduction or surgical referral.
Definitive Treatment
Mild cases with minimal displacement: Immobilisation with a thumb spica splint for 4-6 weeks to allow healing.
Significant displacement or severe thumb instability: Surgical intervention is required to repair the ligament and fix the bone fragment with screws or sutures.
Post-treatment, physiotherapy is essential to restore thumb mobility, strength, and stability.
Commentaires