Ligament Injuries of the Hand and Wrist

A normal-looking radiograph can hide a ligament injury that becomes stiffness, deformity, or arthritis if it is missed.In this episode of Plastics in Practice, we connect reduction, stability testing, imaging, early motion, and operative decision points across finger, thumb, carpal, and distal radioulnar joint injuries.Key takeaways:• Treat the PIP joint as a motion emergency: permanent stiffness can develop within about two weeks. After reduction, confirm congruity and stability, then begin early protected motion when the joint is stable.[1]• Use the thirty-fifty rule as a guide for dorsal PIP fracture-dislocations: less than thirty percent articular involvement is usually stable, thirty to fifty percent is tenuous, and more than fifty percent is usually unstable. Clinical stability still overrides fragment size.[1]• Avoid axial traction during reduction of a dorsal finger MCP dislocation. Traction can pull the volar plate into the joint and convert a simple injury into an irreducible complex dislocation.• For a thumb UCL injury, no firm endpoint is the strongest red flag for a complete tear; angle thresholds vary. A Stener lesion places the adductor aponeurosis between the ligament and bone, blocking anatomic healing.[2,3]• A scapholunate gap around three millimeters or more, an angle above seventy degrees, or dorsal lunate tilt above fifteen degrees supports instability, but normal static films do not exclude a dynamic injury.[4]• On the lateral wrist radiograph, trace the radius, lunate, and capitate. Loss of collinearity plus median nerve symptoms is the perilunate warning pattern; outcomes are better when treatment begins within seven days than after delay.[5]This content is for educational purposes only and is not medical advice.🎧 Full episodes available now:Instagram: https://www.instagram.com/plasticsinpractice/ Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z?si=JNcBxQmwT2mfz1LSJZEFKA Apple: https://podcasts.apple.com/us/podcast/plastics-in-practice-resident-review/id1835564216 YouTube: https://youtube.com/@plasticsinpractice?si=tqLInp5vvsJFKlRO Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/ 📘 Free Study Guides: → https://drive.google.com/drive/u/0/folders/12BUldPbCmihG-ndZh6992WqhRYyxw8ZZ#HandLigamentInjury #WristInstability #PIPJoint #SkierThumb #Scapholunate #Perilunate #HandSurgery #PlasticSurgeryEducation #PlasticsInPracticeReferences:1. Elfar J, Mann T. Fracture-dislocations of the proximal interphalangeal joint. J Am Acad Orthop Surg. 2013;21(2):88-98. doi:10.5435/JAAOS-21-02-882. Dean B, Rodrigues J, Riley N, et al. Guideline on managing thumb ulnar collateral ligament injuries: the British Society for Surgery of the Hand Evidence for Surgical Treatment findings and recommendations. J Hand Surg Eur Vol. 2024;49(10):1195-1201. doi:10.1177/175319342412746123. Qamhawi Z, Shah K, Kiernan G, et al. Diagnostic accuracy of ultrasound and magnetic resonance imaging in detecting Stener lesions of the thumb: systematic review and meta-analysis. J Hand Surg Eur Vol. 2021;46(9):946-953. doi:10.1177/17531934219930154. Dietrich TJ, Toms AP, Cerezal L, et al. Interdisciplinary consensus statements on imaging of scapholunate joint instability. Eur Radiol. 2021;31(12):9446-9458. doi:10.1007/s00330-021-08073-85. van der Oest MJW, Duraku LS, Artan M, et al. Perilunate injury timing and treatment options: a systematic review. J Wrist Surg. 2022;11(2):164-176. doi:10.1055/s-0041-1735841