Sallameh Jafar, Mansour Majd, Mansour Abdallah N, Afif Ali, Klayshe Abdalkareem, Shahin Emad
Department of Orthopedic surgery, Tishreen University Hospital, Latakia, Syria.
Cancer Research Center, Tishreen University Hospital, Latakia, Syria.
Ann Med Surg (Lond). 2024 Aug 8;86(9):5627-5630. doi: 10.1097/MS9.0000000000002439. eCollection 2024 Sep.
Avascular necrosis (AVN) is a rare occurrence in the carpal region, especially in the triquetrum bone, which presents a diagnostic puzzle due to its infrequency and lack of trauma history. This case study explores the signs, diagnosis, and treatment of AVN in a healthy 22-year-old individual, emphasizing the need for early identification using suitable imaging methods.
A 22-year-old patient complained of persistent wrist pain, specifically on the ulnar side, without any history of injury. Clinical examination revealed tenderness without signs of inflammation, with normal sensation and movement. Initial X-ray results were inconclusive, prompting further investigation with MRI, which showed a decrease in signal intensity in the triquetrum bone, leading to the diagnosis of AVN.
The development of AVN involves compromised blood flow, often due to various factors. While AVN affecting carpal bones is uncommon, the triquetrum bone's robust blood supply typically protects against such conditions. However, this case highlights an exceptional occurrence. Gelberman's classification underscores the triquetrum's vascular nature, explaining why AVN is rare in this bone. MRI plays a crucial role in detecting AVN, especially when symptoms do not align with X-ray findings.
Avascular necrosis should be considered in carpal bones, even without a history of trauma, with a focus on MRI for early detection. Although AVN of the triquetrum is rare, this case underscores the importance of timely recognition and conservative management. Further research is necessary to establish optimal treatment strategies for this unusual presentation.
缺血性坏死（AVN）在腕部区域较为罕见，尤其是在三角骨，由于其发病率低且缺乏创伤史，给诊断带来了难题。本病例研究探讨了一名22岁健康个体的AVN体征、诊断和治疗，强调了使用合适的影像学方法进行早期识别的必要性。
一名22岁患者主诉腕部持续疼痛，特别是尺侧，无任何受伤史。临床检查发现压痛但无炎症迹象，感觉和运动正常。最初的X线检查结果不明确，促使进一步进行MRI检查，结果显示三角骨信号强度降低，从而诊断为AVN。
AVN的发生涉及血流受损，通常由多种因素引起。虽然影响腕骨的AVN并不常见，但三角骨丰富的血液供应通常可预防此类情况。然而，本病例突出了一种特殊情况。Gelberman的分类强调了三角骨的血管性质，解释了为什么AVN在该骨中罕见。MRI在检测AVN方面起着关键作用，尤其是当症状与X线检查结果不一致时。
即使没有创伤史，腕骨也应考虑缺血性坏死，重点是通过MRI进行早期检测。虽然三角骨的AVN罕见，但本病例强调了及时识别和保守治疗的重要性。需要进一步研究以确定针对这种不寻常表现的最佳治疗策略。
