الفهرس 
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Abstract
Ulnar collateral ligament displacement from underneath the adductor aponeurosis was assumed to be the cause behind closed treatment failure (Stener’s assumption). The thorough and accurate diagnosis of site of failure is essential for formulating a treatment plan . The stability stress testing of M.C.P joint of thumb can accurately establish M.C.P joint instability and can diagnose complete tear of collateral ligaments of M.C.P joint. Feeling of a soft end-point is a diagnostic sign of complete tear.
Radiographic examination was found not only useful in showing the possibility of an associated avulsion fracture with collateral ligament injuries, but also to exclude the possibility of other fractures in the thumb ray concomitant with collateral ligament tears . An avulsion fracture can be illusive, a bone fragment in place does not mean the ligament is attached to it and not displaced.
Magnetic resonance imaging is useful for evaluating collateral ligament tears, particularly in patients in whom confusing clinical signs are present . MR arthrography proved to be the most sensitive to the diagnosis of a torn collateral ligament of the first metacarpophalangeal joint and of displacement of the torn ligament. Successful management of acute injuries of ulnar and radial collateral ligaments prevents the sequlae of instability and pain. Non operative treatment of partial collateral ligament injuries with cast or splint immobilization will result in a stable and painless thumb.
The essential components of surgical repair are anatomic re-attachement of the collateral ligaments, volar plate, and dorsal capsule, followed by protection in a cast or splint.
Static reconstruction by the use of bone retinaculum autograft is characterized by important features : (1) The material used for ligament reconstruction is not tendon but a ligament-like structure with elastic properties that approximate those of the ligament to be replaced ; and (2) the graft is fixed with screws at a bone-bone interface.
Unlike the dynamic techniques, this procedure leaves the periarticular muscle and tendon apparatus intact which is of great importance for the stability of the joint
The advantages of dynamic techniques by the use of local tendons are good viability of the graft because of preserved blood supply and avoidance of an additional incision for harvesting of the free tendon graft..
Five years follow showed, the bone graft for treatment of chronic collateral ligament injuries to have healed and the joint to be stable with 80 % of the range of motion of the normal side .Arthrodesis is an accepted and proven procedure for the arthritic unstable joint.