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Radial Collateral Ligament Disruption

- 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