Nagura Nana, Naito Kiyohito, Zemirline Ahmed, Sugiyama Yoichi, Kinoshita Mayuko, Goto Kenji, Iwase Yoshiyuki, Kaneko Kazuo
Department of Orthopaedics, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
Department of Orthopaedic Surgery, Juntendo Tokyo Koto Geriatric Medical Center, 3-3-20 Shinsuna, Koto-ku, Tokyo, 136-0075, Japan.
Ann Med Surg (Lond). 2018 Oct 10;35:185-188. doi: 10.1016/j.amsu.2018.10.006. eCollection 2018 Nov.
We report the case of volar dislocation of the ulnar head occurred after osteosynthesis for the treatment of distal radius fracture.
The patient, 68-year-old female, had the dorsal displaced left distal radius fracture and volar dislocation of the ulnar head. Osteosynthesis was performed using a volar locking plate without postoperative immobilization. Two weeks after surgery, volar dislocation of the ulnar head in distal radioulnar joint (DRUJ) was noted on CT. Re-operation, triangular fibrocartilage complex (TFCC) was sutured to the ulnar fovea using a suture anchor, was performed in order to stabilize DRUJ. At 24 months after surgery, left wrist joint pain and the range of motion have improved, and the Mayo wrist score was excellent.
Based on the fact that the radius was fractured and the ulna was dislocated in DRUJ at the time of injury, the present case may have been a Galeazzi fracture.
When distal radius fracture is complicated by ulnar instability of DRUJ, active repair of the TFCC function may be necessary to prevent residual postoperative instability.
我们报告一例桡骨远端骨折切开复位内固定术后发生尺骨头掌侧脱位的病例。
患者为68岁女性，左侧桡骨远端骨折背侧移位伴尺骨头掌侧脱位。采用掌侧锁定钢板进行切开复位内固定，术后未进行制动。术后两周，CT检查发现尺桡远侧关节（DRUJ）尺骨头掌侧脱位。为稳定DRUJ，进行了再次手术，使用缝合锚将三角纤维软骨复合体（TFCC）缝合至尺骨凹。术后24个月，左手腕关节疼痛及活动范围改善，Mayo腕关节评分优秀。
鉴于损伤时桡骨骨折且DRUJ尺骨脱位，本病例可能为盖氏骨折。
当桡骨远端骨折合并DRUJ尺骨不稳定时，可能需要积极修复TFCC功能以防止术后残留不稳定。
