Afshar Ahmadreza, Tabrizi Ali, Aidenlou Ali
Department of Orthopedics, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran.
J Hand Microsurg. 2020 Apr 9;13(4):238-242. doi: 10.1055/s-0040-1701157. eCollection 2021 Oct.
This case report describes a 74-year-old man with the rare injury of transscaphoid dorsal lunate dislocation (LD). He sustained a crushing injury with a huge amount of energy to his right wrist while working with a pressing machine. There were deep abrasions and areas of skin necrosis on the dorsum of the wrist. The patient was treated with closed reduction and a Herbert screw fixation for the scaphoid fracture. Six months postoperatively, avascular necrosis (AVN) of the lunate and scaphoid was apparent on the wrist radiographs. We offered a proximal row carpectomy to the patient, but he declined surgery because he was able to perform his activity of daily living. Dorsal LD as well as its variants has a high prevalence of AVN of the lunate. Delayed diagnosis, delayed treatment, and open reduction increase the risk of AVN development of the lunate. The level of evidence is therapeutic IV.
本病例报告描述了一名74岁男性,患有罕见的经舟状骨月骨背侧脱位(LD)。他在操作冲压机时右手腕遭受了巨大能量的挤压伤。腕背部有深部擦伤和皮肤坏死区域。患者接受了闭合复位及Herbert螺钉固定治疗舟状骨骨折。术后6个月,腕部X线片显示月骨和舟状骨出现缺血性坏死(AVN)。我们向患者提出了近端排腕骨切除术,但他因能够进行日常生活活动而拒绝手术。月骨背侧脱位及其变异型发生月骨AVN的几率很高。延迟诊断、延迟治疗及切开复位会增加月骨发生AVN的风险。证据级别为治疗性IV级。