Elghoul Naoufal, Jalal Youssef, Bouya Ayoub, Zine Ali, Jaafar Abdeloihab
Department of Orthopedic Surgery and Traumatology, Military Hospital Mohamed V (HMIMV), BP 10100 Rabat, Morocco.
J Orthop Case Rep. 2018 Sep-Oct;8(5):29-31. doi: 10.13107/jocr.2250-0685.1196.
Pure isolated dislocations of the fifth carpometacarpal joint are extremely rare. To the best of our knowledge, the case, we present here, is among the extremely rare cases report of an unstable hamatometacarpal dislocation(HMD)injury successfully treated by a well-molded cast.
A 30-year-old rider fell from his horse, causing swelling of the wrist and the fifth finger was rotated with minimal active motion. The radiological assessment (X-rays and tomography) showed a pure HMD. Under sedation, we performed reduction of the dislocation. However, the reduction was lost at the slightest movement requiring a K-wirefixation. The patient refused the surgical treatment and requested non-operative treatment. Thus, while the joint was held in a reduced position, a well-molded plaster cast was applied which immobilized both the hamatometacarpal joint and the metacarpophalangeal joint. Later, the patient was reviewed weekly until 6 weeks, then the cast was removed altogether and the digits were mobilized. At the follow-up of 6 months, he had regained full range of motion of the little finger with no pain, no recurrence of dislocation and returned to his previous level of sporting activity.
The early detection with careful clinical assessment and radiological analysis for subtle signs, followed by appropriate treatment usually leads to an excellent result.
单纯孤立的第五掌指关节脱位极为罕见。据我们所知，我们在此呈现的病例是极为罕见的不稳定钩掌关节脱位（HMD）损伤，通过精心塑形的石膏成功治疗的病例报告之一。
一名30岁的骑手从马背上摔下，导致手腕肿胀，第五指旋转，主动活动极少。影像学评估（X线和断层扫描）显示为单纯HMD。在镇静状态下，我们进行了脱位复位。然而，稍有活动复位就会丢失，需要克氏针固定。患者拒绝手术治疗，要求非手术治疗。因此，在关节保持复位的情况下，应用了精心塑形的石膏，固定钩掌关节和掌指关节。之后，每周对患者进行复查，直至6周，然后完全拆除石膏，活动手指。在6个月的随访中，他小指的活动范围已完全恢复，无疼痛，无脱位复发，并恢复到之前的运动水平。
早期通过仔细的临床评估和影像学分析检测细微体征，随后进行适当治疗，通常会取得良好的效果。
