第二指橈骨手根骨脱臼。症例報告と文献のレビュー

Volar Radiocarpal Dislocation: A Case Report and Review of Literature.

• Mohammed Sabr
• Hosam T Mashrah
• Abdulaziz H Abed
• Hamdi Arabi
• Fawaz Pullishery

抄録

橈骨脱臼（RCD）は手首に起こる稀な外傷の一つで、手根骨と橈骨遠位部の接触が部分的または完全に失われているものである。我々は25歳の男性患者の手根骨脱臼の症例を紹介する。左前腕の手首に痛みを訴えて救急外来を受診した。この患者は交通事故に遭い，前院で前腕ギプスを装着されていた．初診では毛細血管充填は良好で目に見える変形はなく腫脹が認められたが、X線画像では骨折は認められず、再度前腕ギプスを装着して整形外科を受診した。レントゲン写真を確認したところ、左手首全尖性RCDとの診断ミスが見つかり、直ちに外科的治療を行うことになった。全身麻酔下で閉鎖縮小術を行い、左橈骨関節に経皮的キルシュナーワイヤーを3本平行に固定して治療を行った。可動域改善のための作業療法と筋力強化を行い、臨床経過観察で伸展、屈曲、筋力の改善が認められた。本人は結果に満足しており、3ヶ月後の経過観察では新たな問題は認められなかった。

Radiocarpal dislocations (RCDs) are one of the rare injuries that happen to the wrist in which there is a partial or complete loss of contact between the carpus and distal radius. We present the case of volar RCD in a 25-year-old male patient. He reported to the ED with pain on the wrist of his left forearm. The patient had met with a motor vehicle accident and was put on forearm cast in the previous hospital. Initial clinical examination showed swelling with no visible deformity with good capillary fill; X-ray images showed no fracture, and he was again put on forearm cast giving an orthopedic clinic appointment. A missed diagnosis of left wrist complete volar RCD was found when we reviewed the X-ray, and the patient was called for immediate surgical treatment. He was treated under general anesthesia with closed reduction, and three parallel percutaneous Kirschner wires were pinned to the left radiocarpal joint. Occupational therapy to improve the range of motion and muscle strengthening were done, and clinical follow-up showed improvement in the extension, flexion, and muscle power. The patient was satisfied with the outcome and after three months of follow-up showed no new problems.

Copyright © 2020, Sabr et al.