Langenhan R, Hohendorff B, Probst A
HBH-Kliniken Singen, Klinik für Orthopädie, Unfall- und Handchirurgie, Singen.
Handchir Mikrochir Plast Chir. 2011 Jun;43(3):140-6. doi: 10.1055/s-0031-1271802. Epub 2011 Apr 6.
Fractures of the hamate body and the base of the fourth metacarpal bone in the coronal plane with or without a dislocation of the base of the fifth metacarpal bone are rare. Clenched fist punches are considered to be the main cause. The diagnosis of the fracture dislocation is often missed on routine radiographs. Posterior-anterior, lateral, and oblique views are required for native radiological evaluation. A CT scan can help in the assessment of severity and for preoperative planning. Unless minimal displacement is present, non-surgical treatment does not lead to satisfying outcome. Displaced fractures of the hamate body and the base of the fourth metacarpal bone with or without subluxation of the hamatometacarpal joint should be stabilised by open reduction and internal fixation (ORIF). Controversy exists about the surgical treatment of choice. Screw or K-wire fixation with postoperative cast immobilisation for 6 weeks and consecutive hardware removal has been found to result in excellent clinical and radiological outcomes. This study presents 2 cases of coronal fractures of the body of the hamate and the base of the fourth metacarpal bone with subluxation of the hamatometacarpal V joint. Anatomy, epidemiology, classification, mechanism, clinical symptoms, diagnostic features, and therapy options for these injuries are discussed.
钩骨体和第四掌骨基部在冠状面的骨折，伴或不伴有第五掌骨基部脱位，较为罕见。紧握拳头打击被认为是主要原因。骨折脱位在常规X线片上常被漏诊。进行原生放射学评估需要正位、侧位和斜位片。CT扫描有助于评估严重程度和术前规划。除非移位极小，非手术治疗不会带来满意的结果。钩骨体和第四掌骨基部的移位骨折，伴或不伴有钩掌关节半脱位，应通过切开复位内固定（ORIF）进行稳定处理。关于手术治疗的选择存在争议。已发现使用螺钉或克氏针固定并术后石膏固定6周，随后取出内固定物，可带来优异的临床和放射学结果。本研究呈现了2例钩骨体和第四掌骨基部冠状面骨折伴钩掌关节V半脱位的病例。讨论了这些损伤的解剖学、流行病学、分类、机制、临床症状、诊断特征和治疗选择。
