Goyal Tarun
Tarun Goyal, Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh 248201, India.
World J Orthop. 2017 Aug 18;8(8):656-659. doi: 10.5312/wjo.v8.i8.656.
Association of fracture of trapezium with Bennett's fracture is very rare and makes reduction and stabilisation more difficult. We are reporting a rare case of Bennett's fracture with fracture of the trapezium and subluxation of the carpo-metacarpal joint (CMC) joint. The patient was a 47-year-old school teacher who fell from his motorbike on his outstretched right dominant hand. Radiographs and computed tomography showed fracture of the trapezium with subluxation of the CMC joint, associated with Bennett's fracture. Open reduction and internal fixation was carried out. Trapezium was reduced first and secured with a 2 mm diameter screw. Bennett's fracture was then reduced and fixed with two per-cutaneously placed Kirchner's wires. CMC was stabilised with per-cutaneous Kirchner's wires. Latest follow up at 12 mo showed a healed fracture with good reduction of the CMC joint. Clinically patient had no pain and normal extension, abduction and opposition of the thumb. QuickDASH score was 3.9/100. Thus, fracture of trapezium associated with a Bennett's fracture is a rare injury and if ignored it may lead to poor results. This injury is more challenging to manage than an isolated Bennett's fracture as anatomical reduction of the trapezium with reduction of the first CMC is needed. Fracture of the trapezium should be fixed first as this will provide a stable base for reduction of the Bennett's fracture.
大多角骨骨折与班尼特骨折同时发生的情况非常罕见，会使骨折复位和固定变得更加困难。我们报告了一例罕见的班尼特骨折合并大多角骨骨折及腕掌关节半脱位的病例。患者是一名47岁的学校教师，他骑摩托车时摔倒，伸出的右手（优势手）着地。X线片和计算机断层扫描显示大多角骨骨折伴腕掌关节半脱位，合并班尼特骨折。进行了切开复位内固定术。先将大多角骨复位，并用一枚直径2毫米的螺钉固定。然后将班尼特骨折复位，经皮置入两根克氏针固定。腕掌关节用经皮克氏针固定。术后12个月的最新随访显示骨折愈合，腕掌关节复位良好。临床上患者无疼痛，拇指伸展、外展和对掌功能正常。QuickDASH评分为3.9/100。因此，大多角骨骨折合并班尼特骨折是一种罕见的损伤，如果忽视可能导致不良后果。这种损伤比单纯的班尼特骨折更具挑战性，因为需要对大多角骨进行解剖复位并复位第一腕掌关节。应先固定大多角骨骨折，因为这将为班尼特骨折的复位提供一个稳定的基础。
