Tension wire fixation of avulsion fractures at the thumb metacarpophalangeal joint

Avulsion fractures of the thumb metacarpophalangeal joint require adequate treatment to prevent instability or articular incongruity. Open reduction and internal fixation may be difficult because of the small fracture fragment size. Nine patients underwent acute open reduction and tension wire fixation of displaced or rotated avulsion fractures. Follow-up examination was at approximately 26 months. All fractures healed in anatomic alignment without instability or articular incongruity. Pain, stiffness, and loss of pinch, were subjectively rated as none in six patients and mild in three. The injured thumb demonstrated firm stability in extension and 30° flexion in all patients. Metacarpophalangeal and interphalangeal motion averaged 77% and 97% of the opposite hand respectively. Planar and palmar abduction averaged 96%. Pinch strength in apposition averaged 97% and in opposition 99% of the uninvolved hand. Grip strength was 96% of the contralateral extremity.