In this study, Dr. A. Badia from the Miami Hand Center reports the results of arthroscopy used to treat 12 cases of unstable Gamekeeper's thumb. This condition is called gamekeeper's thumb because Scottish gamekeepers commonly injured their thumbs as a result of their job. It is also referred to as skier's thumb because it is a common injury among downhill skiers. All 12 patients were college athletes injured while playing sports.

In each case, the thumb was hyper-abducted. This means the thumb was pulled away from the hand so far that the ulnar collateral ligament was torn away from the bone. This strong band of tissue is attached to the middle joint of the thumb, the joint next to the web space of the thumb. All injuries included a small piece of bone attached to the end of the ligament called an avulsion fracture.

Dr. Badia described the surgical technique in detail. Steps in the procedure include traction of the thumb and removal of blood or fragments in the area of the fracture. Then the synovium (the outer covering of cartilage over the joint) was removed. This gives the surgeon better access to the joint.

The detached bone fragment was rotated to line up with the main part of the bone. A K-wire (pin) was used to hold the fragment in place. Both fluoroscopy (a type of X-ray) and arthroscopy were used to make sure the piece of bone is in its proper place. This must be done before applying a cast.

Once the pin was removed, a short course of hand therapy was prescribed. The goal was to regain motion and strength. Most patients can resume all activities within eight weeks' time.

The advantages of arthroscopic repair of Gamekeeper's thumb include:

Less inflammation and swelling after surgery

The author concludes that arthroscopic repair of a Gamekeeper's thumb with bone fragment is preferred over an open technique.

Alejandro Badia, MD. Arthroscopic Reduction and Internal Fixation of Bony Gamekeeper's Thumb. In Orthopedics. August 2006. Vol. 29. No. 8. Pp. 675-678.

 Post to Del.icio.us

 Email to a Friend