Niitsuma Gaku, Kawasaki Keikichi, Inagaki Katsunori
Department of Orthopaedic Surgery, Showa University School of Medicine, Hatanodai, Shinagawa-Ku, Tokyo, Japan.
Department of Orthopaedic surgery, Showa University Northern Yokohama Hospital, Chigasaki-Chuou, Tsuzuki-Ku, Kanagawa, Japan.
J Orthop Case Rep. 2022 Dec;12(12):1-5. doi: 10.13107/jocr.2022.v12.i12.3440.
We present a rare case of ischemia caused by blunt trauma at the metacarpophalangeal joint, with no fracture or dislocation. This case resulted in digital arterial injury of the little finger with a pathological mechanism similar to that of hypothenar hammer syndrome (HHS).
Pre-operative computed tomography (CT) revealed an occluded ulnar artery at the brachial artery bifurcation and occluded ulnar digital artery in the little finger. The blunt trauma to the radial digital artery of the little finger caused ischemia. Arterial anastomosis was performed microsurgically to preserve the little finger. Necrosis was successfully prevented. The condition of the finger improved gradually, with no restriction in the range of motion.
When a patient presents with HHS-like symptoms and is unresponsive to conservative treatment, surgical treatment should be considered. We recommend using contrast-enhanced CT for evaluating the entire upper extremity, even for ischemia associated with blunt hand trauma, such as HHS.
我们报告一例罕见的掌指关节钝性创伤导致的缺血病例,无骨折或脱位。该病例导致小指指动脉损伤,其病理机制与小鱼际锤状指综合征(HHS)相似。
术前计算机断层扫描(CT)显示肱动脉分叉处尺动脉闭塞,小指尺侧指动脉闭塞。小指桡侧指动脉的钝性创伤导致缺血。通过显微外科手术进行动脉吻合以保住小指。成功预防了坏死。手指状况逐渐改善,活动范围无受限。
当患者出现类似HHS的症状且对保守治疗无反应时,应考虑手术治疗。我们建议使用增强CT评估整个上肢,即使是对于与手部钝性创伤相关的缺血,如HHS。