RESUMEN
A patient reported that he sustained a minor fall on the outstretched hand in hyperextension, pronation, and in ulnar deviation. Initial radiographs suggested dorsal transscaphoid-transtriquetral perilunate dislocation. Traditionally, however, this injury is the result of a high-energy impact. A CT scan obtained after closed reduction of the dislocation revealed not only a fresh fracture of the triquetrum but also two corticalized fragments of the scaphoid. A former major fall on this hand and a normal scaphoid of the other hand made pseudarthrosis more likely than scaphoid bipartition. Arthrography revealed intact lunotriquetral and scapholunate ligaments, precluding the possibility of preexisting ligamentous instability. Pseudarthrosis of the scaphoid with a loss of scaphoid function as a mechanical tie-rod of the carpus is most likely responsible for this complex injury. This is the first clinical study that shows that single scaphoid discontinuity without preexisting ligamentous carpal instability may lead to complex perilunar dislocation in minor trauma.
Asunto(s)
Luxaciones Articulares/diagnóstico por imagen , Seudoartrosis/diagnóstico por imagen , Traumatismos de la Muñeca/diagnóstico por imagen , Adulto , Huesos del Carpo/diagnóstico por imagen , Huesos del Carpo/lesiones , Fracturas Óseas/complicaciones , Fracturas Óseas/diagnóstico por imagen , Humanos , Luxaciones Articulares/complicaciones , Masculino , Seudoartrosis/complicaciones , Radiografía , Hueso Escafoides/diagnóstico por imagen , Hueso Escafoides/lesionesRESUMEN
Scapholunate dissociation is a well-known injury in adult patients. In pediatric patients, repair of this injury in the skeletally immature carpus has been previously reported. However, in none of these case studies is single ligamentous suture performed. We report a case of scapholunate dissociation in a 9-year-old boy after an initial Salter I injury of the distal radius. After 6 weeks of wrist immobilization, arthroscopy was performed due to persisting pain over the scapholunate gap, a positive Watson sign, and limited range of motion. This arthroscopy revealed intraligamentous rupture of the scapholunate ligament. Suture repair of the scapholunate ligament was performed. The suture was protected by a temporary K-wire arthrodesis for 8 weeks. One year after removal of the K-wire, the patient is completely free of symptoms and resumes all sport activities.
Asunto(s)
Ligamentos Articulares/lesiones , Ligamentos Articulares/cirugía , Hueso Semilunar , Hueso Escafoides , Traumatismos de la Muñeca/cirugía , Artroscopía , Niño , Estudios de Seguimiento , Humanos , Inestabilidad de la Articulación/etiología , Inestabilidad de la Articulación/cirugía , Masculino , Rango del Movimiento Articular , Rotura , Suturas , Factores de Tiempo , Traumatismos de la Muñeca/diagnósticoAsunto(s)
Huesos del Carpo/diagnóstico por imagen , Ligamentos Articulares/lesiones , Osteoartritis/etiología , Traumatismos de la Muñeca/complicaciones , Articulación de la Muñeca/diagnóstico por imagen , Adulto , Humanos , Masculino , Osteoartritis/diagnóstico por imagen , Radiografía , Traumatismos de la Muñeca/diagnóstico por imagenRESUMEN
Mediastinal parathyroid adenoma located on the 5th ectopic gland is rare. We report here two new cases diagnosed by scintigraphy. In one case the adenoma was found to be located in the mediastinum prior to cervicotomy. The modern imaging methods capable of locating parathyroid adenomas are evaluated.