Zoakman Sahel, Rhemrev Steven J
Het Röpcke-Zweers Ziekenhuis, afd. Spoedeisende Hulp, Hardenberg.
Ned Tijdschr Geneeskd. 2013;157(34):A6082.
Evaluating patients with wrist injuries is diagnostically challenging. Physical examination alone is not sufficient for establishing a diagnosis and fractures of the wrist region are not always visible on x-rays.
In this article, we present a case of a patient who had sustained trauma to the wrist and was taken care of at the emergency department. The mechanism of trauma and clinical findings strongly indicated a fracture of the scaphoid bone. No abnormality was visible on x-rays; the fracture was treated by casting nonetheless. On a CT scan performed later, there indeed appear to be a non-dislocated fracture of the capitate bone present. The diagnosis was confirmed by bone scintigraphy a few days later. The patient recovered without complications.
Fractures of the capitate bone are serious carpal injuries that must be treated as aggressively as fractures of the scaphoid bone. Conventional radiological examinations cannot rule out a fracture of the wrist; if doubt persists, readily accessible imaging techniques (such as CT or MRI) should be conducted.
评估腕部损伤患者在诊断上具有挑战性。仅通过体格检查不足以确诊,腕部区域的骨折在X射线下也并非总是可见。
在本文中,我们呈现了一例腕部遭受创伤并在急诊科接受治疗的患者。创伤机制和临床发现强烈提示舟状骨骨折。X射线下未见异常;尽管如此,骨折仍采用石膏固定治疗。在随后进行的CT扫描中,确实发现头状骨存在无移位骨折。几天后通过骨闪烁显像确诊。患者康复且无并发症。
头状骨骨折是严重的腕骨损伤,必须像舟状骨骨折一样积极治疗。传统放射学检查不能排除腕部骨折;如果仍有疑问,应采用易于获得的成像技术(如CT或MRI)进行检查。