Department of Orthopaedics, Maulana Azad Medical College & Lok Nayak Hospital, New Delhi, India.
JBJS Case Connect. 2020 Jul-Sep;10(3):e19.00558. doi: 10.2106/JBJS.CC.19.00558.
We present a rare combined convergent-divergent carpometacarpal (CMC) fracture dislocation with median nerve involvement in a young adult after a motorbike accident. Radiographs revealed a volar dislocation of the second and fifth metacarpals and dorsal dislocation of the third and fourth metacarpals with bases of the second and fifth metacarpals found to be converging in the coronal plane. Open reduction and fixation was performed with carpal tunnel release.
Combined convergent-divergent CMC fracture dislocation should be kept as a differential while evaluating CMC dislocations. Metacarpal cascade line (posteroanterior view) and 2 lateral views (radial side up and ulnar side up) with computed tomography scan (3-dimensional reconstruction) prove to be vital in such high-energy trauma.
我们报告了一例罕见的摩托车事故后导致的伴有正中神经损伤的掌指关节（CMC）合并屈戍关节骨折脱位的年轻患者。X 线片显示第二和第五掌骨掌侧脱位，第三和第四掌骨背侧脱位，第二和第五掌骨基底部在冠状面上呈会聚。行切开复位内固定术，并同时行腕管松解术。
在评估 CMC 脱位时，应将合并的会聚-发散型 CMC 骨折脱位作为鉴别诊断。在这种高能量创伤中，掌骨级联线（前后位）和 2 个侧位（桡侧抬高和尺侧抬高）加 CT 扫描（三维重建）证明是至关重要的。
