Radial Collateral Ligament Disruption

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- Discussion:
    - as with ulnar injuries, a mid subtance tear is rare;
- Treatment Acute Tears:
    - if there is no instability and no sign of volar subluxation, the thumb
        is immobilized for 3 to 4 weeks;
- Surgical Treatment:
    - after curved incision and mobilization of skin flaps, longitudinal
          incision is made in the abductor aponeurosis volar to EPB tendon,
          leaving a rim of tissue on the tendon for later closure;
    - aponeurosis is reflected dorsally and volarly, exposing the dorsal
          capsule and radial collateral ligament, respectively;
    - ruptured ligament is then resutured into either the proximal phalanx
          or metacarpal, depending on the bone from which it ruptured;
    - any volar subluxation of the phalanx must be reduced and the dorsal
          capsule and the EPB repaired;
    - generally in these situations, the joint is transfixed with a K wire
          for several weeks;
- Chronic Radial Collateral Ligament Tear:
    - phalanx in a chronic radial collateral ligament injury rotates into
          pronation;
    - correcting the rotational deformity is important, and this can only be
          accomplished by repairing the ligament;
    - w/ chronic radial collateral ligament injuries the ligament will be
          deficient in 33% of cases and will require free tendon graft;
          (as compared to game keepers thumb in which 66% of patients require
          free tendon grafts);
    - after reconstruction, additional stability is obtained by tightening
          conjoined tendon of insertion of the abductor pollicis brevis
          & the radial head of the FPB;