Department of Radiology, Logan University, 1851 Schoettler Road, Chesterfield, MO, 63017, USA.
Chiropractic Health Centers, Logan University, 1851 Schoettler Road, Chesterfield, MO, 63017, USA.
J Ultrasound. 2021 Mar;24(1):91-97. doi: 10.1007/s40477-018-0308-3. Epub 2018 Jul 14.
To describe a patient with an occult isolated trapezoid fracture of the wrist. Isolated trapezoid fractures are very difficult to detect without advanced radiological imaging, since the fragment displacement does not occur in the sagittal plane. A discussion regarding the investigation of trapezoid fractures utilizing multiple imaging modalities includes the first demonstration of its detection via ultrasonography (US).
A 26-year-old male presented to a chiropractic teaching clinic with pain involving the left wrist, after vaulting over the handlebars of his bicycle 2 days prior. The mechanism of injury was hyperflexion of the left wrist. Left wrist pain, reduced range of motion, and dorsal soft tissue edematous changes were identified at examination. Although the initial radiographic examination was negative, elevated clinical suspicion triggered an US examination 4 days later. The US exam demonstrated an isolated 1.8 mm dorsal trapezoid fracture, which was minimally displaced by 0.7 mm.
Following the US diagnosis of an isolated trapezoid fracture, the wrist was immobilized. The patient elected to not pursue an orthopedic consultation. Conservative care included ice and Class IV therapeutic laser therapy. The patient reported complete alleviation of clinical symptoms after approximately 2 weeks of splinting and treatment.
We emphasize the limitations of radiography in the diagnosis of this fracture. To our knowledge, this is the first case to describe the use of US in the diagnosis of an isolated trapezoid fracture.
描述一例腕部隐匿性孤立性舟状骨骨折患者。由于该骨折块未在矢状面发生移位，因此在没有先进影像学检查的情况下，很难发现孤立性舟状骨骨折。本文讨论了利用多种影像学手段检查舟状骨骨折的方法，首次通过超声（US）检查显示了其检测方法。
一位 26 岁男性两天前在骑自行车时车把翻倒，导致左手腕疼痛，到脊骨神经科教学诊所就诊。受伤机制为左手腕过伸。体格检查发现左手腕疼痛、活动范围减小，以及背侧软组织肿胀。尽管初始的放射学检查为阴性，但由于临床高度怀疑，在 4 天后进行了 US 检查。US 检查显示一处 1.8mm 的背侧舟状骨骨折，轻度移位 0.7mm。
US 诊断为孤立性舟状骨骨折后，对手腕进行了固定。患者选择不寻求骨科会诊。保守治疗包括冰敷和 4 级治疗性激光治疗。患者报告在夹板固定和治疗约 2 周后，临床症状完全缓解。
我们强调了放射学在诊断这种骨折中的局限性。据我们所知，这是首例描述 US 在诊断孤立性舟状骨骨折中的应用的病例。
