The evaluation and treatment of injuries of the ulnar collateral ligament of the metacarpopha. langeal joint of the thumb remain controversial. In a retrospective study that was done to assess our ability to determine whether displacement of the ligament (a Stener lesion) was present, we reviewed our accumulated[ experience with patients who had an injury of this lig.. ament who were treated surgically between 1972 and 1984. Since our method of evaluation changed in 1977, we compared the preoperative and operative diagnoses in the twenty patients who were treated surgically from 1972 through 1976 with those in the twenty patients who were so treated from 1977 through 1984. Considering all forty patients who were treated operatively, sixteen (40 per cent) had a typical Stener lesion, and in two others (5 per cent) the ulnar collateral ligament was rolled up ~on itself and lying beneath the adductor aponeurosis. From 1972 through 1976, stability was tested with the metacarpophalangeal joint in complete extension or in varying amounts of flexion. Of the twenty thumbs that were evaluated by this technique and.were treated surgically, 20 per cent had a Stener lesion. From 1977 through 1984, stability was tested with the joint in full flexion because of the findings in anatomical stfidies that were completed in 1977; the incidence of a Stener lesion in the twenty thumbs that were treated by repair or reattachment of the ligament during this time was 70 per cent. We believe that when no fracture is present, a proper physical examination of an injured thumb is sufficient to determine the degree of instability of the ulnar collateral ligament, and that a five-stage grading system of injuries that appear to involve the ulnar side of the metacarpophalangeal joint of the thumb is helpful in separating them into operative and non-operative groups. * No benefits in any form have been received or Will be received from a commercial party related directly or indirectly to the subject of this article. No funds were received in support of this study.

Forty-seven bipolar hemiarthroplasties were performed from January 1985 to December 1986. Twenty-three patients (24 hips) returned for a history, physical, and repeat radiographs. Ten primary press-fit and two cemented primary bipolar hemiarthroplasties were performed. Four patients underwent cemented and eight received press-fit revision bipolar hemiarthroplasties. Fourteen patients had simultaneous cancellous, reamed femoral head autograft, or allograft acetabular bone augmentation. Omitting one patient who had replacement for Leri's pleonosteosis, the average acetabular migration among the remaining 23 patients was 4 mm of superior and 1.5 mm of medial progression. The mean modified d'Aubigne hip score was 33 for primary press-fit arthroplasty, 30 for primary cemented arthroplasty, 22 for pressfit revisions, and 32 for cemented bipolar revision arthroplasty. Morcellized bone graft tended to variably resorb with time. Among the press-fit stems, all but two patients complained of at least occasional thigh pain. All but one patient with primary press-fit hemiarthroplasty walked with a limp. We conclude that, although good early results can be obtained, significant number of patients will have groin and thigh pain. We have found no evidence either radiologically or clinically that nonstructural bone grafting with reamed femoral head will reliably incorporate or prevent further acetabular migration.