Kurozumi Taketo, Saito Masato, Odachi Kazuhiko, Masui Fumiaki
Trauma Center, Toranomon Hospital, Tokyo 105-8470, Japan.
Department of Orthopedic Surgery, Chiba-Nishi General Hospital, Chiba 270-2251, Japan.
World J Clin Cases. 2023 Oct 6;11(28):6871-6876. doi: 10.12998/wjcc.v11.i28.6871.
We report a case with the displacement of an articular fracture fragment of the base of the second metacarpal from the ulnar to the volar side, treated the dorsal approach. The dorsal approach can be a good option not only because it allows direct observation of ligament damage and fixation of bone fragments but also because the thin subcutaneous tissue makes the approach easier.
A 45-year-old man with a right hand injury visited the hospital. A small bone fragment was identified using plain radiography. Lateral radiography revealed the fragment as lying over the volar aspect of the carpometacarpal (CMC) joint. Computed tomography revealed that approximately one-third of the CMC joint surface of the second metacarpal was damaged. We provisionally diagnosed an intra-articular fracture with significant CMC joint instability and performed open reduction and internal fixation. We made a dorsal longitudinal incision over the CMC joint between the second and third metacarpals. The dorsal ligament of the third CMC joint was torn. We thought it had been dislocated to the volar side and spontaneously reduced to that position. There are only few reports of volar dislocation of CMC joint fractures, particularly of the second and third metacarpals; our report is unique as our patient had an intact interosseous ligament between the second and third metacarpals.
Although past reports have used a palmar approach, the dorsal approach is a good option for these cases.
我们报告一例第二掌骨基底关节骨折碎片从尺侧向掌侧移位的病例，采用背侧入路进行治疗。背侧入路可能是一个不错的选择，这不仅是因为它能直接观察韧带损伤情况并固定骨碎片，还因为其皮下组织较薄，使手术入路更简便。
一名右手受伤的45岁男性前来就诊。通过X线平片发现一个小骨碎片。侧位X线片显示该碎片位于腕掌关节（CMC）掌侧。计算机断层扫描显示第二掌骨的CMC关节面约三分之一受损。我们初步诊断为关节内骨折伴严重的CMC关节不稳定，并进行了切开复位内固定术。我们在第二和第三掌骨之间的CMC关节处做了一个背侧纵向切口。第三CMC关节的背侧韧带撕裂。我们认为它已向掌侧脱位并自行复位到该位置。关于CMC关节骨折掌侧脱位的报道很少，尤其是第二和第三掌骨；我们的报告很独特，因为我们的患者第二和第三掌骨之间的骨间韧带完整。
尽管过去的报道采用掌侧入路，但背侧入路对于这些病例是一个不错的选择。
