Department of Orthopaedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang-si, Gyeonggi-do, South Korea.
Department of Radiology, Seoul Paik Hospital, Inje University College of Medicine, Seoul, South Korea.
J Hand Surg Asian Pac Vol. 2022 Apr;27(2):376-380. doi: 10.1142/S2424835522720122. Epub 2022 Apr 19.
Multiple dorsal fracture-dislocations of the carpometacarpal joints (CMCJ) occur from very high-energy trauma and are often associated with soft tissue injury or ischaemia. We report a 54-year-old male manual worker and a smoker who presented to the emergency room with history of compression of his right hand in a press machine. Radiographs showed dorsal fracture-dislocations of the scapho-trapezio-trapezoidal and third to fifth CMCJ's. Despite emergent Guyon canal and carpal tunnel release and closed reduction and pinning, skin pallor persisted in all digits. Brachial angiography revealed total occlusion of the radial and ulnar arteries and loss of the palmar arch at the level of the fracture. Heparin and Alprostadil were injected directly. On follow-up angiography three weeks later, the vessels were still occluded and collaterals provided digital circulation. Although digital sensations recovered, cold intolerance and stiffness resulted in a poor functional outcome. Level V (Therapeutic).
多处腕掌骨背侧骨折脱位（CMCJ）由极高能创伤引起，常伴有软组织损伤或缺血。我们报告了一位 54 岁的男性体力劳动者和吸烟者，他的右手在压力机中被挤压，到急诊就诊。X 线片显示舟状骨-大多角骨-小多角骨和第三至第五 CMCJ 的背侧骨折脱位。尽管紧急行 Guyon 管和腕管松解以及闭合复位和钢针固定，但所有手指的皮肤仍苍白。肱动脉造影显示桡动脉和尺动脉完全闭塞，骨折处手掌弓消失。直接注入肝素和前列地尔。三周后的随访血管造影显示血管仍闭塞，侧支循环提供了手指循环。尽管手指感觉恢复，但怕冷和僵硬导致功能预后不良。5 级（治疗）。
