case_images: PMC11788873_01
case_images: X-rays (A) demonstrating bony UCL avulsion (yellow arrow), with Stener lesion on MRI (B, yellow arrow). Intraoperative fluoroscopy image following repair (C).. UCL, ulnar collateral ligament; MRI, magnetic resonance imaging.
case_images: cureus-0017-00000076892-i01.jpg
case_images: PMC11788873_01_cureus-0017-00000076892-i01.jpg
case_images: FIG1
case_images: Subsequent magnetic resonance imaging (MRI) revealed an avulsed complete UCL tear with a Stener lesion with a small bony fragment attached to the UCL (Figure 1A, 1B).
case_images: Unicortical tunnel drill hole placement.. UCL, ulnar collateral ligament; MC, metacarpal.. Image credit: VA.
case_images: cureus-0017-00000076892-i02.jpg
case_images: PMC11788873_01_cureus-0017-00000076892-i02.jpg
case_images: FIG2
case_images: The small bone fragment was excised from the UCL, and a repair was performed per the one-hole drill technique described below (Figures 2-5). The suture ends were then passed through the sutured loop, and the UCL was cinched to the fractured bed and secured (Figures 2-5). This is performed using a 0.045 inch K-wire (Figure 2).
case_images: Suture is passed through the UCL, with suture loop formed.. UCL, ulnar collateral ligament.. Image credit: VA.
case_images: cureus-0017-00000076892-i03.jpg
case_images: PMC11788873_01_cureus-0017-00000076892-i03.jpg
case_images: FIG3
case_images: The small bone fragment was excised from the UCL, and a repair was performed per the one-hole drill technique described below (Figures 2-5). The suture ends were then passed through the sutured loop, and the UCL was cinched to the fractured bed and secured (Figures 2-5). Using a double-armed 5-0 Prolene or a similar suture, both needles are passed through the tunnel into the avulsion site creating a loop that protrudes from the K-wire hole (Figure 3).
case_images: Lark knot created by passing suture needles through a suture loop over the bone bridge.. Image credit: VA.
case_images: cureus-0017-00000076892-i04.jpg
case_images: PMC11788873_01_cureus-0017-00000076892-i04.jpg
case_images: FIG4
case_images: The small bone fragment was excised from the UCL, and a repair was performed per the one-hole drill technique described below (Figures 2-5). The suture ends were then passed through the sutured loop, and the UCL was cinched to the fractured bed and secured (Figures 2-5). The needles are then passed through the suture loop to form a Lark's knot (Figure 4).
case_images: UCL is gently advanced into the avulsion site and the suture is fixed to UCL to secure repair.. UCL, ulnar collateral ligament.. Image credit: VA.
case_images: cureus-0017-00000076892-i05.jpg
case_images: PMC11788873_01_cureus-0017-00000076892-i05.jpg
case_images: FIG5
case_images: The small bone fragment was excised from the UCL, and a repair was performed per the one-hole drill technique described below (Figures 2-5). The suture ends were then passed through the sutured loop, and the UCL was cinched to the fractured bed and secured (Figures 2-5). UCL with a locking knot to fix the UCL to the avulsion site (Figure 5). Under direct visualization, the repair may be gently tested.
case_images: A transosseous tunnel through the avulsion site and the distal cortex is created using a Keith needle.. MC, metacarpal.. Image credit: VA.
case_images: cureus-0017-00000076892-i06.jpg
case_images: PMC11788873_01_cureus-0017-00000076892-i06.jpg
case_images: FIG6
case_images: Following dissection and debridement of the UCL, a Keith needle is loaded into a pin driver and driven through the avulsion site through the distal cortex (Figure 6).
case_images: Suture is placed into the UCL and the suture needles are passed through the needle eyelet.. UCL, ulnar collateral ligament.. Image credit: VA.
case_images: cureus-0017-00000076892-i07.jpg
case_images: PMC11788873_01_cureus-0017-00000076892-i07.jpg
case_images: FIG7
case_images: The needles are then passed through the Keith needle eyelet (Figure 7).
case_images: Suture is passed through the tunnel by advancing the needle and secured using an external button.. UCL, ulnar collateral ligament.. Image credit: VA.
case_images: cureus-0017-00000076892-i08.jpg
case_images: PMC11788873_01_cureus-0017-00000076892-i08.jpg
case_images: FIG8
case_images: The suture is then knotted down over a button or a pledget on the skin to secure the repair (Figure 8).
case_images: Two-hole drilling technique.. MC, metacarpal.. Image credit: VA.
case_images: cureus-0017-00000076892-i09.jpg
case_images: PMC11788873_01_cureus-0017-00000076892-i09.jpg
case_images: FIG9
case_images: Two unicortical tunnels are prepared dorsal and distally to the UCL avulsion site using a 0.045 inch K-wire (Figure 9).
case_images: The suture is passed through both drill holes and the tendon. The suture is then knotted down over the bony bridge, advancing the UCL tendon to the avulsion site.. UCL, ulnar collateral ligament.. Image credit: VA.
case_images: cureus-0017-00000076892-i10.jpg
case_images: PMC11788873_01_cureus-0017-00000076892-i10.jpg
case_images: FIG10
case_images: The suture needle is then passed back through the second drill hole (Figure 10).