Primary Results of Hook Plate Fixation Technique for Ulnar Collateral Ligament Fracture-Avulsion: A Case Study

Document Type : RESEARCH PAPER


1 Department of Orthopedic Surgery, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

2 Department of Hand and Microsurgery, Panzdahe Khoradad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran


Background: Ulnar collateral ligament(UCL) fracture-avulsion of the thumb which involves small osseous fragments 
is among common injuries to the thumb metacarpophalangeal (MCP) joint.
Methods: This case series was conducted on 11 patients (9 males and 2 females) with a mean age of 25.4±4.8 years 
with acute traumatic UCL fracture-avulsion with instability and Stener Lesion. A low-profile 2-mm stainless steel hook 
plate with a 2-mm screw was used for the internal fixation. Immobilization was performed for 10 days. Range of motion 
movements (ROM), grip power, and pinch strength were measured after three months. At the end of the follow-up 
period, functional outcomes were determined by the visual analog scale (VAS), and Quick Disabilities of the Arm, 
Shoulder, and Hand (Quick DASH). 
Results: The mean follow-up period was reported as 12.4±2.3 months. the union of avulsed small osseous fragments 
occurred at the end of the three-month follow-up. A number of 10 patients were treated by one hole 2-mm plate with 
a screw and a mean VAS score of 22.5±2.4, while a female patient had more severe pain with a mean score of 45. 
This patient complained about the irritation of the plate, especially in the thumb grip. The mean Quick DASH score was 
9.6±1.4. The postoperative ROM was similar to that of the other side. Grip power and pinch strength were lower in the 
treated thumb, as compared to that in the opposite side; nonetheless, the difference was not statistically significant. 
Conclusion: As evidenced by the obtained results, it can be concluded that the hook plate technique is a strong 
fixation method for thumb UCL fracture-avulsion, raising the possibility of earlier joint movements and rapid recovery; 
nevertheless, in some cases, it can reduce efficiency and induce painful grip.
Level of evidence: I


  1. Patel A, Patel A, Edelstein D, Choueka J. Fluoroscopy-assisted stress testing of the thumb metacarpophalangeal joint to assess the ulnar collateral ligament. Hand. 2013; 8(2):205-9.
  2. Tsiouri C, Hayton MJ, Baratz M. Injury to the ulnar collateral ligament of the thumb. Hand. 2009; 4(1):12-8.
  3. Madan SS, Pai DR, Kaur A, Dixit R. Injury to ulnar collateral ligament of thumb. Orthopaedic surgery. 2014; 6(1):1-7.
  4. Rocchi L, Merolli A, Morini A, Monteleone G, Foti C. A modified spica-splint in postoperative early-motion management of skier’s thumb lesion: a randomized clinical trial. European Journal of Physical and Rehabilitation Medicine. 2013; 50(1):49-57.
  5. Bovard RS, Derkash RS, Freeman JR. Grade III avulsion fracture repair on the UCL of the proximal joint of the thumb. Orthopaedic review. 1994; 23(2):167-9.
  6. Moharram AN. Repair of thumb metacarpophalangeal joint ulnar collateral ligament injuries with microanchors. Annals of Plastic Surgery. 2013; 71(5):500-2.
  7. Kang GC, Yam A, San Phoon E, Lee JY, Teoh LC. The hook plate technique for fixation of phalangeal avulsion fractures. JBJS. 2012; 94(11):e72.
  8. Tabrizi A, Afshar A. Hook plate fixation for the thumb ulnar collateral ligament fracture-avulsion. Journal of Hand and Microsurgery. 2017; 9(02):095-7.
  9. Mahajan M, Rhemrev SJ. Rupture of the ulnar collateral ligament of the thumb–a review. International journal of emergency medicine. 2013; 6(1):1-6.
  10. Dinowitz M, Trumble T, Hanel D, Vedder NB, Gilbert M. Failure of cast immobilization for thumb ulnar collateral ligament avulsion fractures. The Journal of hand surgery. 1997; 22(6):1057-63.
  11. Shin EH, Drake ML, Parks BG, Means Jr KR. Hook plate versus suture anchor fixation for thumb ulnar collateral ligament fracture-avulsions: a cadaver study. The Journal of Hand Surgery. 2016; 41(2):192-5.
  12. Lee SY, Woo SH, Kang HJ. Mini Hook Plate Fixation for the Thumb Ulnar Collateral Ligament Fracture-Avulsion. Archives of Hand and Microsurgery. 2019; 24(2):142-51.