case_images: PMC11650722_01
case_images: Case 1: Radiograph and intraoperative findings.. (A) Stener lesion with ruptured adductor aponeurosis and distal end of the UCL (*); (B and C) Insight of the MCP joint with rotated avulsion fracture of the proximal phalanx (#); (D) Reduced fracture with anchor thread; (E) Scheme of anchor refixation; (F) 4 weeks post-operative radiograph MCP joint (dp) of the right thumb.
case_images: ICRP_A_2441186_F0001_C.jpg
case_images: PMC11650722_01_ICRP_A_2441186_F0001_C.jpg
case_images: F0001
case_images: Radiographs showed a displaced and 90  rotated fracture fragment of the proximal phalanx base (#), as well as a conspicious saucer-type ulnar-sided fragment at the level of the distal first metacarpal bone (*) (Figure 1(A)). Intraoperatively, the UCL was flipped back at the partially ruptured aponeurosis with a small bone fragment (*) attached to the distal end of the UCL (Figure 1(B)). Incision of the aponeurosis and capsule distally revealed a dislocated and rotated fracture fragment (#) of the proximal phalanx base, which had no contact with the UCL (Figure 1(C)). The ligament was then fixed on top of the bone fragment (Figure 1(D,E)). After 4 weeks of immobilization in a short thumb spica splint, the fracture was largely healed (Figure 1(F)).
case_images: PMC11650722_02
case_images: Case 2: Radiograph of the right thumb.. (A) X-ray (dp) with fracture fragment at the proximal phalanx base (#) and osseous fragment at the distal UCL (*). (B) lateral view.
case_images: ICRP_A_2441186_F0002_B.jpg
case_images: PMC11650722_02_ICRP_A_2441186_F0002_B.jpg
case_images: F0002
case_images: Radiographs showed a slightly dislocated fracture of the distal phalanx, a dislocated osseous fragment at the ulnar base of the proximal phalanx, and a second shell-like osseous fragment further proximal in projection to the soft tissue as indicators of a two-level injury (Figure 2).
case_images: PMC11650722_03
case_images: Case 3: Radiograph and intraoperative findings.. (A) Preoperative radiograph of the right thumb (pd) in the cast. (B) Intraoperative findings of the first MCPj of the right thumb showing a fracture at the proximal phalanx base (#) and the unattached distal end of the ulnar collateral ligament (*). (C) Intraoperative radiograph after repositioning and reattachment of the fracture and UCL.
case_images: ICRP_A_2441186_F0003_C.jpg
case_images: PMC11650722_03_ICRP_A_2441186_F0003_C.jpg
case_images: F0003
case_images: On radiography, a 90  rotated fracture fragment at the proximal phalanx base was observed (Figure 3(A)). The joint-bearing fragment lied further distally, flipped by 90  (#) (Figure 3(B)). While the joint-bearing fragment was large enough for refixation, the shell fragment was not (Figure 3(C)).