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创伤性脑损伤患者漏诊的月骨周围脱位:一例报告

Missed Perilunate Dislocation in a Post-Traumatic Head Injury Patient: A Case Report.

作者信息

Meleppuram Jimmy Joseph, Jacob Bobby

机构信息

Department of Orthopaedics, Centre of excellence in Orthopaedics and Rheumatology, Aster Medcity Hospital, Kochi, Kerala, India.

出版信息

J Orthop Case Rep. 2022 Sep;12(9):65-68. doi: 10.13107/jocr.2022.v12.i09.3020.

Abstract

INTRODUCTION

Perilunate injuries are rare, complex, and high velocity trauma associated injuries accounting to <10% of wrist joint trauma. Volar peri-lunate dislocations account for <3% of these injuries. Perilunate injuries should, therefore, be focused and ruled out while examining a patient complaining wrist pain after high-energy accidents which are often missed.

CASE REPORT

We report a case of, missed dislocation in a patient who presented delayed with wrist pain, post 4 months road traffic accident associated with heterotrophic ossified mass in a united scapular fracture. He underwent open reduction through a combined approach and internal fixation with K-wires. Aggressive wrist physiotherapy retrieved near-normal range of motion at the wrist by the end of 5 months as well as neither revealed recurrence of the dislocation nor signs of avascular necrosis.

CONCLUSION

Successful results in perilunate injuries can be obtained with open reduction, ligament reconstruction with K-wires fixation through a single combined approach in delayed presentation resulting in achieving near normal range of movements.

摘要

引言

月骨周围损伤罕见、复杂,是与高速创伤相关的损伤,占腕关节创伤的不到10%。掌侧月骨周围脱位占这些损伤的不到3%。因此,在检查因高能事故导致手腕疼痛的患者时,应重点排查月骨周围损伤,此类损伤常被漏诊。

病例报告

我们报告一例患者,在道路交通事故4个月后因手腕疼痛前来就诊,漏诊了脱位情况,同时该患者还伴有肩胛骨骨折愈合后形成的异位骨化肿块。他通过联合入路进行了切开复位并用克氏针内固定。积极的手腕物理治疗在5个月末使手腕活动范围恢复至接近正常,且未出现脱位复发及缺血性坏死迹象。

结论

对于延迟就诊的月骨周围损伤,通过单一联合入路进行切开复位、用克氏针固定韧带重建,可取得成功的治疗效果,使活动范围接近正常。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/655c/9983395/44a6e44981e0/JOCR-12-65-g001.jpg

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