月骨周围掌侧骨折脱位

目的探讨月骨周围掌侧骨折脱位的临床表现及治疗结果。方法对5例腕部复合损伤造成月骨周围掌侧骨折脱位的患者,其中2例(急性开放损伤)采用清创术,腕骨骨折脱位复位后予克氏针内固定或前臂外固定支架固定;3例为陈旧性损伤,行近排腕骨切除,其中2例同时行骨间背侧神经切除。结果5例随访时间平均为14．4个月。术后腕关节主动运动功能为掌屈15°～40°,平均20°;背伸20°～50°,平均35°;桡偏5°～10°,平均8°;尺偏10°～20°,平均12°。3例日常活动时腕关节疼痛,4例握物时力弱,1例X线片发现有舟月骨间分离;1例术后6个月重返原工作岗位,余4例仍残留其他部分功能障碍需进一步治疗。结论月骨周围掌侧骨折脱位由直接暴力作用所引起,临床易引起漏诊。由于损伤暴力大,常造成开放性多组织复合损伤,延误诊断是导致疗效不满意的主要原因。     

Irreducible trans-scaphoid perilunate dislocation

Two cases of irreducible trans-scaphoid perilunate dislocation are described. In each case there was soft tissue interposition between the proximal and distal elements of the fracture-dislocation and this prevented capitolunate and scaphoid reduction. The dorsal capsule was impaled on the distal scaphoid fragment in one case, and a flap of dorsal capsule was entrapped between the capitate and the lunate in the other. In light of these findings, we recommend a dorsal approach for open reduction of trans-scaphoid perilunate dislocation when the capitolunate joint cannot be reduced by closed manipulation.     

Trans-triquetral dorsal perilunate fracture dislocation

A rare case of trans-triquetral dorsal perilunate dislocation is described. It differs from the Mayfield and Johnson theory of progressive perilunar instability in greater arc injuries which states that the injury passes from the radial to the ulnar carpal bones and soft tissues in stages. This injury supports the concept of a reverse greater arc injury from ulnar to radial being possible with the radial carpal bones being spared in some cases.     

Recurrent dorsal trans-scaphoid perilunate dislocation

A case is presented in which trans-scaphoid perilunate dislocation occurred through a scaphoid non-union. The place of open reduction and immediate bone grafting is discussed.     

月骨周围脱位的X线分析

月骨周围脱位多发生于活跃的青壮年男性,是一种严重的腕部损伤,主要依靠腕关节X线检查和临床查体诊断。由于腕关节结构复杂,临床易误诊、漏诊,若诊断或治疗不当,极易引起骨缺血坏死、腕不稳及创伤性关节炎等严重并发症,     

掌侧入路手术治疗急性月骨周围骨折-脱位

目的评价掌侧入路手术治疗急性月骨周围骨折-脱位的方法及疗效。方法对2010-2017年收治的11例急性月骨周围骨折-脱位患者采用掌侧入路,术中复位月骨周围脱位,固定合并的骨折,修复掌侧关节囊韧带,术中判断月骨周围关节稳定则不再行关节内固定术,术后石膏托制动4周。末次随访采用Mayo腕关节评分评定疗效。结果术中修复掌侧关节囊韧带及固定合并的骨折后,10例月骨周围关节稳定,1例仍存在舟月关节分离,加用克氏针固定。11例均获得随访,随访时间9~17个月,末次随访,所有患者均重返原工作岗位。患侧腕关节平均屈伸活动度为106.2°,平均握力相当于健侧的87%。采用Mayo腕关节评分评价腕关节功能:优6例,良4例,可1例。结论采用掌侧入路切开复位、修复掌侧关节囊韧带、不常规使用关节内固定的方法治疗急性月骨周围骨折-脱位疗效满意。     

Transscaphoid transcapitate transtriquetral perilunate fracture-dislocation: a case report

We present a rare stage III greater arc fracture-dislocation of the carpus including transscaphoid, transcapitate, and transtriquetral dorsal perilunate fracture-dislocation.     

Bipolar dislocation of the forearm: elbow and perilunate dislocation

We report a case of bifocal dislocation of the forearm due to posterior dislocation of the elbow and transcaphocapital retrolunate dislocation of the carpus, Fenton's syndrome, associated with fracture of both bones of the forearm. The emergency procedure achieved reduction of the elbow, plate fixation of the radius and ulna, used a posterior and an anterior access to achieve reduction and osteosynthesis of the radial styloid, the scaphoid, and the capitatum and temporary schapholunate, triquetrolunate, scaphocapitate, and radiolunate pinning. At ten months, the patient only complained of moderate pain for exceptional efforts. Complete amplitude elbow motion was restored. Wrist flexion and extension were 50 degrees and 30 degrees respectively. X-rays demonstrated union of the scaphoid and the capitatum. There was no scapholunate diastasis and the scapholunate angle was normal.     

Arthroscopy for hip dislocation and fracture-dislocation

We reviewed consecutive patients undergoing hip arthroscopy for loose bodies after sustaining hip dislocations and fracture-dislocations not requiring open fracture management. Eleven patients were identified, all with intra-articular loose bodies diagnosed by computed tomography. After 3 weeks, all patients underwent hip arthroscopy in which loose bodies were removed and labral pathology debrided. No patient developed any of the complications (avascular necrosis, heterotopic ossification, nerve injury) associated with hip arthrotomy. Arthroscopic treatment of intraarticular loose bodies after hip dislocations and fracture-dislocations allows excellent joint visualization for loose body removal and labral tear diagnosis and treatment.     

The floating forearm: elbow and perilunate dislocation

To the five cases published in the literature concerning concomitant elbow and perilunate dislocation, the authors add a sixth case and discuss the epidemiologic, clinical and therapeutic characteristics of this complex injury.     

Translunate, perilunate fracture-dislocation of the wrist. A case report

The following case report presents an unusual translunate, perilunate fracture-dislocation. To our knowledge, this occurrence has not been reported previously.     

Complete dorsal dislocation of the carpal scaphoid with perilunate dorsal dislocation

Complete dorsal dislocation of the carpal scaphoid combined with dorsal perilunate dislocation is an extremely rare carpal injury. We describe the case of a 23-year-old man who presented with a complete dorsal dislocation of the carpal scaphoid, combined with a perilunate dislocation. Surgical treatment was performed with open reduction and interosseus ligament repair. At 4 years follow up, the patient''s wrist pain had completely resolved without limitations of wrist joint motion and without evidence of avascular necrosis of the carpal scaphoid.     

Two stage procedure for neglected transscaphoid perilunate dislocation

We report a two-staged surgical procedure for neglected 3 month old volar transscaphoid, transcapitate perilunate fracture dislocation wrist in an 18 year old right handed male student. The lunate with proximal scaphoid and proximal capitate maintained its articulation with distal end radius while the rest of carpal bones had dislocated volarly. In the first stage, bilateral uniplanar wrist distractor was applied with the aim of stretching soft tissue. In the next stage open reduction and internal fixation was done by a combined volar and dorsal approach augmented by pronator quadratus flap. At 3 years followup the patient was pain free and had a full range of supination pronation of the forearms and radial and ulnar deviation of wrist with 10° dorsiflexion deficit.