Nakayama Masanori, Sakuma Yu, Tobimatsu Haruki
Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare (IUHW), Mita Hospital, 1-4-3, Mita, Minato-ku, Tokyo, 108-8329, Japan.
Department of Orthopedic Surgery, Tokyo Women's Medical University, Japan.
Int J Surg Case Rep. 2020;68:96-99. doi: 10.1016/j.ijscr.2020.01.056. Epub 2020 Feb 6.
A volar dislocation of the metacarpophalangeal (MCP) joint of the thumb is a rare trauma, and in combination with a radial collateral ligament (RCL) injury is much rarer. We present a surgical case with a recurrent volar dislocation of the MCP joint of the thumb with RCL injury.
A 47-year-old man was referred to our hospital in the subacute phase. Open reduction was performed through a dorsal incision and the RCL was repaired. X-rays taken six weeks later revealed a recurrent dislocation of the MCP joint. At the revision surgery, the extensor pollicis brevis (EPB) was detached from the proximal phalanx. As there was volar tightness, the volar plate was incised horizontally and the EPB was attached to the proximal phalanx. The final X-rays six months post-operatively revealed that the MCP joint was slightly subluxated but there was no pain on motion.
This case revealed that it is not enough only to repair the RCL to reduce a volar dislocation of the MCP joint of the thumb with an RCL injury. It revealed that re-attachment of the extensor tendons and the volar procedure are also important for a perfect reduction of a recurrent volar dislocation of the MCP joint of the thumb.
For a volar dislocation of the MCP joint of the thumb with RCL injury, it is important not only to repair the RCL, but also to perform arthroplasty with the extensor tendons and a volar procedure to prevent recurrent dislocation after surgery.
拇指掌指关节掌侧脱位是一种罕见的创伤，合并桡侧副韧带损伤则更为罕见。我们报告一例伴有桡侧副韧带损伤的复发性拇指掌指关节掌侧脱位的手术病例。
一名47岁男性在亚急性期转诊至我院。通过背侧切口进行切开复位并修复桡侧副韧带。六周后拍摄的X线片显示掌指关节复发性脱位。在翻修手术中，拇短伸肌从近节指骨上分离。由于掌侧紧张，将掌板水平切开，拇短伸肌重新附着于近节指骨。术后六个月的最终X线片显示掌指关节轻度半脱位，但活动时无疼痛。
该病例表明，对于伴有桡侧副韧带损伤的拇指掌指关节掌侧脱位，仅修复桡侧副韧带是不够的。这表明伸肌腱重新附着和掌侧手术对于拇指掌指关节复发性掌侧脱位的完美复位也很重要。
对于伴有桡侧副韧带损伤的拇指掌指关节掌侧脱位，不仅要修复桡侧副韧带，还需进行伸肌腱成形术和掌侧手术，以防止术后复发性脱位。
