Lopes Jorge Gomes, Relvas-Silva Miguel, Serdoura Francisco, Sousa António, Vidinha Vitor
Department of Orthopaedics and Traumatology, Centro Hospitalar Universitário São João, Portugal.
Department of Orthopedics and Traumatology, Casa de Saúde da Boavista, Porto, Portugal.
J Orthop Case Rep. 2023 Apr;13(4):25-29. doi: 10.13107/jocr.2023.v13.i04.3602.
About 20% of all fractures in the human skeleton involves the hand, affecting primarily the young and active population. A Bennett's fracture (BF) is a fracture of the base of the first metacarpal and surgical management is generally needed, with the K-wire fixation being the most preferred option. Among the most common complications with K-wires, we find infection and soft-tissues damages like tendon ruptures.
Here, we report a case of iatrogenic rupture of the Little Finger's Flexor Profundus Tendon after K-wire fixation of a BF that was diagnosed 4 weeks after the lesion. Different surgical strategies were proposed for managing chronic flexor tendon's ruptures; however, no consensus exist around what option would be the best. Here, we describe a flexor transfer from the 5th to the 4th finger that resulted in a great improvement in patient's DASH score and general quality of life.
It is important to remember that percutaneous fixations with K wires in the hand can have disastrous complications, patients should be evaluated for possible tendon ruptures after the surgery, no matter how impossible they may seem, as even unexpected complications can have easier solutions in the acute setting.
人体骨骼中约20%的骨折涉及手部,主要影响年轻且活跃的人群。班尼特骨折(BF)是第一掌骨基部骨折,通常需要手术治疗,克氏针固定是最常用的选择。在克氏针最常见的并发症中,我们发现有感染和软组织损伤,如肌腱断裂。
在此,我们报告一例在BF克氏针固定后发生的医源性小指指深屈肌腱断裂病例,该病例在损伤后4周被诊断出来。针对慢性屈肌腱断裂提出了不同的手术策略;然而,对于哪种选择是最佳选择尚无共识。在此,我们描述了一种从第5指到第4指的屈肌转移术,该手术使患者的DASH评分和总体生活质量有了显著改善。
必须记住,手部克氏针经皮固定可能会产生灾难性并发症,术后应评估患者是否可能发生肌腱断裂,无论看起来多么不可能,因为即使是意外并发症在急性期也可能有更简单的解决办法。