Radial collateral ligament injury of the thumb with a Stener-like lesion.

The original Stener lesion, described in 1962, refers to an ulnar collateral ligament tear of the thumb metacarpophalangeal joint with adductor aponeurosis interposition. The adductor aponeurosis serves as a mechanical block to healing by preventing apposition of the torn ends of the ulnar collateral ligament. This article presents a case of a 27-year-old woman with painful swelling of the thumb metacarpophalangeal joint following a car accident. Complete tear of the radial collateral ligament was diagnosed based on physical and radiographic examinations. Radial collateral ligament injuries are reported to be less common than ulnar collateral ligament injuries, and, in the past, radial collateral ligament tears were thought to be innocuous, requiring little intervention. More recently, the significance of these injuries has been well documented, and there is support for acute surgical management of complete radial collateral ligament tears. During surgical intervention in our case, we found an intrasubstance tear of the radial collateral ligament with the proximal portion of the ligament retracted and lying superficial to the abductor aponeurosis, thereby producing a Stener-like lesion on the radial side of the joint. The incidence of a Stener-like lesion to the radial collateral ligament is unknown, but it has only been reported once in the literature. Although a primary radial collateral ligament tear may heal by soft tissue apposition, we felt that conservative management in our patient would unlikely lead to healing due to interposition of the abductor aponeurosis. This case supports current recommendations for surgical intervention of complete radial collateral ligament injuries due to the possibility of a Stener-like lesion with soft tissue interposition recurring in the future.

The effect of resident work hour regulations on orthopaedic surgical education.

Accreditation Council for Graduate Medical Education (ACGME) resident work hour regulations have been effective since July 2003. Several areas affected by these changes have been identified, including surgical education. In the current study, the authors evaluated the impact of these changes on surgical education at a two-person-per-year orthopaedic training program. Operative case experiences of PGY 2 and 3 residents during the academic years 2002-2003 and 2003-2004 were compared utilizing ACGME case logs. A data entry log was also distributed to examine subjectively the effects on operative case load. ACGME data showed that PGY 2 and 3 residents performed 21.5% fewer cases between years. The average number of cases per rotation decreased by 20.44% (p =.009, paired t-test). Subjective results also showed a decrease, with an average of 10.8% of cases missed per resident. This study shows that residents who have begun training post-80-hour work week will do fewer procedures. This may result in a decreased level of skill, or it may shift operative experience to the senior resident years, prolonging the learning curve. Regardless, future analysis must be done to determine the full impact on training of the orthopaedic resident.