PDF(Pubmed)
Abstract：
BACKGROUND Scaphocapitate syndrome is a rare clinical entity consisting of a combined scaphoid and capitate fracture along with a 90- or 180-degrees rotation of the proximal capitate fragment. The syndrome is scarcely described in the literature, with proximal migration of the capitate fragment being reported only by Mudgal et al in 1995. Concurrent compression of the median nerve is a highly unfortunate event, suggesting a unique case presented here. CASE REPORT We present a unique case of scaphocapitate fracture-dislocation in a 25-year-old man with volar dislocation of the capitate\'s fragment deep to the median nerve. X-rays and CT scan were performed and the patient was treated few hours after the injury by a hand specialist, in order to prevent median neuropathy and avascular necrosis of the fragment. Open reduction and internal fixation utilizing a Herbert screw for the scaphoid fracture and 3 additional K-wires was performed. Immediately post-operatively, the acute neurological symptoms had subsided and good reduction was acquired radiologically. One year post-operatively the patient had regained good hand and wrist functionality, with no extension or flexion ROM deficits. CONCLUSIONS Immediate intervention in a specialized center with reduction and fixation utilizing a Herbert screw and K-wires showed favorable 1-year results in our case of scaphocapitate syndrome. The impending complications of median neuropathy and capitate avascular necrosis were avoided despite the high-risk injury pattern.
摘要：
背景技术肩胛骨综合征是一种罕见的临床实体，包括舟骨和头状骨折以及近端头状碎片的90度或180度旋转。该综合征在文献中几乎没有描述，头状片段的近端迁移仅在1995年由Mudgal等人报道。同时压迫正中神经是非常不幸的事件，提出了一个独特的案例。案例报告我们介绍了一个25岁男性的肩cap骨骨折脱位的独特案例，头状骨碎片在正中神经深处的掌侧脱位。对病人进行了X线和CT扫描,伤后数小时由一名手部专科医生治疗,以防止正中神经病变和缺血坏死的片段。使用Herbert螺钉治疗舟骨骨折的切开复位和内固定，并额外进行了3根K线。术后立即，急性神经系统症状已消退，放射学上已获得良好的减轻。术后一年，患者恢复了良好的手和手腕功能，没有伸展或弯曲ROM缺陷。结论在一个专门的中心，使用赫伯特螺钉和K线进行复位和固定的即时干预在我们的肩capapitate综合征病例中显示出良好的1年结果。尽管存在高风险的损伤模式，但仍避免了正中神经病和头状缺血性坏死的即将发生的并发症。
