Reigstad Ole, Holm-Glad Trygve, Korslund Johanne, Thorkildsen Rasmus, Røkkum Magne
Orthopedic Department, Martina Hansens Hospital, Baerum, Norway.
Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Ann Jt. 2023 Jan 5;8:9. doi: 10.21037/aoj-22-25. eCollection 2023.
Multiple carpal fractures or fracture dislocations can be devastating to the wrist. Despite anatomical reduction and ligament reconstruction, reduced function and arthrosis is often observed. Simple fractures without ligament injuries often fare well if anatomy is restored and the fracture heals.
A 17-year-old autistic man presented with pilon-type bilateral fractures of the carpals after crashing his bicycle in a car with clenched fists around his bicycle handlebars. He had a displaced scaphoid, minimal displaced capitate and an undisplaced hamate fracture on the left side and an undisplaced scaphoid and displaced two-part capitate fracture on the right side. The fractures were reduced and stable fixation with screws performed. He was immobilized for 2 weeks and allowed early active motion. At 8 weeks the fractures had healed, and he obtained good function. At final follow-up after 6 months his nearest of kin reported excellent function, he had returned to his preinjury activity level. Range of motion and grip-strength was excellent and symmetrical. Radiographs and CT scans revealed healed fractures in anatomical position, no sign of ligament injuries, carpal instability or arthrosis.
Multiple carpal fractures are not necessarily prone to reduced wrist function, pain and arthrosis, even in bilateral cases. If the ligaments are intact, stable fixation obtained and early mobilization obtained the fractures reduced and stable fixation obtained excellent hand and wrist function can be obtained.
多发性腕骨骨折或骨折脱位可对腕关节造成严重破坏。尽管进行了解剖复位和韧带重建，但仍常观察到功能减退和关节病。如果解剖结构得以恢复且骨折愈合，无韧带损伤的单纯骨折通常预后良好。
一名17岁的自闭症男性在骑自行车时紧握车把，与一辆汽车相撞后，出现双侧pilon型腕骨骨折。他左侧有舟骨移位、头状骨轻度移位和钩骨无移位骨折，右侧有舟骨无移位和头状骨两部分移位骨折。对骨折进行了复位并用螺钉进行了稳定固定。他固定了2周，并允许早期主动活动。8周时骨折愈合，他获得了良好的功能。在6个月后的最后随访中，他的近亲报告其功能极佳，已恢复到受伤前的活动水平。活动范围和握力极佳且对称。X线片和CT扫描显示骨折在解剖位置愈合，无韧带损伤、腕骨不稳定或关节病迹象。
即使是双侧多发性腕骨骨折，也不一定容易出现腕关节功能减退、疼痛和关节病。如果韧带完整，获得稳定固定并早期活动，骨折复位且固定稳定，就能获得极佳的手部和腕关节功能。
