長橈側手根伸筋裂離骨折後偽関節の1例
30歳，男性，アフリカ系アメリカ人，米軍の消防士．5か月前，バスケットボール中に転倒し，右手をついて受傷した．同日，右第2中手骨骨折の診断で，2か月間前腕ギプス固定を行われた．右手関節痛が持続し，手背部の骨性隆起を認めたため，当院を紹介された．第2中手骨基部及び手関節背側に圧痛を認めた．手関節背屈は可能だったが，抵抗を加えると疼痛が誘発された．握力は右10 kg,左42 kgと低下していた．単純X線像及びCTにて第2中手骨基部橈側の骨欠損と手関節背側に小骨片を認め，MRIで骨片に長橈側手根伸筋（ECRL）が連続し，陳旧性ECRL裂離骨折後偽関節と診断した．ECRL腱が付着した骨片を原位置に戻し...
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| Published in | 整形外科と災害外科 Vol. 69; no. 2; pp. 376 - 380 |
|---|---|
| Main Authors | , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
西日本整形・災害外科学会
25.03.2020
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0037-1033 1349-4333 |
| DOI | 10.5035/nishiseisai.69.376 |
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| Abstract | 30歳，男性，アフリカ系アメリカ人，米軍の消防士．5か月前，バスケットボール中に転倒し，右手をついて受傷した．同日，右第2中手骨骨折の診断で，2か月間前腕ギプス固定を行われた．右手関節痛が持続し，手背部の骨性隆起を認めたため，当院を紹介された．第2中手骨基部及び手関節背側に圧痛を認めた．手関節背屈は可能だったが，抵抗を加えると疼痛が誘発された．握力は右10 kg,左42 kgと低下していた．単純X線像及びCTにて第2中手骨基部橈側の骨欠損と手関節背側に小骨片を認め，MRIで骨片に長橈側手根伸筋（ECRL）が連続し，陳旧性ECRL裂離骨折後偽関節と診断した．ECRL腱が付着した骨片を原位置に戻して骨移植を行い，tension band wiringによる偽関節手術を行った．術後4週間の前腕ギプス固定後に，関節可動域訓練を開始した．術後4か月で骨癒合が得られた．術後8か月で手関節可動域は制限なく，握力は47 kg（健側40 kg）に改善した．手関節掌背屈時痛や圧痛はなく，原職に復帰した． |
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| AbstractList | 30歳，男性，アフリカ系アメリカ人，米軍の消防士．5か月前，バスケットボール中に転倒し，右手をついて受傷した．同日，右第2中手骨骨折の診断で，2か月間前腕ギプス固定を行われた．右手関節痛が持続し，手背部の骨性隆起を認めたため，当院を紹介された．第2中手骨基部及び手関節背側に圧痛を認めた．手関節背屈は可能だったが，抵抗を加えると疼痛が誘発された．握力は右10 kg,左42 kgと低下していた．単純X線像及びCTにて第2中手骨基部橈側の骨欠損と手関節背側に小骨片を認め，MRIで骨片に長橈側手根伸筋（ECRL）が連続し，陳旧性ECRL裂離骨折後偽関節と診断した．ECRL腱が付着した骨片を原位置に戻して骨移植を行い，tension band wiringによる偽関節手術を行った．術後4週間の前腕ギプス固定後に，関節可動域訓練を開始した．術後4か月で骨癒合が得られた．術後8か月で手関節可動域は制限なく，握力は47 kg（健側40 kg）に改善した．手関節掌背屈時痛や圧痛はなく，原職に復帰した． |
| Author | 金城, 政樹 勝木, 亮 金谷, 文則 大久保, 宏貴 普天間, 朝上 |
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| References | 14) Takami, H., Takahashi, S., Ando, M.: Avulsion fracture of the second metacarpal base by the extensor carpi radialis longus. Arch. Orthop. Trauma Surg., 118: 109-110, 1998. 17) Vandeputte, G., De Smet, L.: Avulsion of both extensor carpi radialis tendons: a case report. J. Hand Surg. Am., 24: 1286-1288, 1997. 18) 吉川泰弘ら：第2中手骨基部裂離骨折3例の治療経験．臨整外，32: 645-648, 1997. 3) Clark, D., et al.: Extensor carpi radialis longus avulsion: a literature review and case report. Hand Surg., 13(3): 187-192, 2008. 5) DeLee, J. C.: Avulsion fracture of the base of the second metacarpal by the extensor carpi radialis longus. A case report. J. Bone Joint Surg. Am., 61: 445-446, 1979. 1) Alnaif, N., et al.: Diagnosis of isolated extensor carpi radialis longus (ECRL) tendon avulsion fracture using ultrasound: a paradigm shift. Skeletal Radiol., 47: 1289-1292, 2018. 10) Najefi, A., et al.: Avulsion fractures at the base of the 2(nd) metacarpal due to the extensor carpi radialis longus tendon: a case report and review of the literature. Arch. Trauma Res., 5: e32872, 2016. 13) Shyamsundar, S.: Avulsion fracture of the extensor carpi radialis longus tendon: case report and literature review. Hand Surg., 17: 247-249, 2012. 11) Punjabi, V., Leong, A.: Avulsion fracture of the base of the index metacarpal by extensor carpi radialis longus: a case report. Int. J. Orthop. Surg., 9-2, 2007. 6) Ghani, Y., Sharma, P. R., Grant, L.: Non-surgical management of an avulsion fracture injury of extensor carpi radialis brevis. Hand Surg., 18: 97-98, 2013. 16) 牛島貴宏ら：橈側手根伸筋腱付着部裂離骨折の治療経験．臨整外，50: 817-821, 2015. 7) Jena, D., Giannikas, K. A., Din, R.: Avulsion fracture of the extensor carpi radialis longus in a rugby player: a case report. Br. J. Sports Med., 35: 133-135, 2001. 9) Mcinnes, J. D.: Avulsion fracture of the base of the second metacarpal. Can. Med. Assoc. J., 57: 379, 1947. 12) Robert, N., et al.: Avulsion fracture of the extensor carpi radialis longus carpal insertion due to a basketball injury: case report and literature review. Chir. Main., 33: 410-412, 2014. 2) Cassell, O. C., Vidal, P.: An unreported cause of rupture of the extensor pollicis longus tendon. J. Hand Surg. Br., 21: 640-641, 1996. 4) Crichlow, T. P., Hoskinson, J.: Avulsion fracture of the index metacarpal base: three case reports. J. Hand Surg. Br., 13: 212-214, 1988. 15) Treble, N., Arif, S.: Avulsion fracture of the index metacarpal. J. Hand Surg. Br., 12: 38-39, 1987. 8) Jessa, K. K., Hodge, J. C.: Avulsion fracture of tendon of extensor carpi radialis longus: unknown mechanism. J. Emerg. Med., 15: 201-207, 1997. |
| References_xml | – reference: 5) DeLee, J. C.: Avulsion fracture of the base of the second metacarpal by the extensor carpi radialis longus. A case report. J. Bone Joint Surg. Am., 61: 445-446, 1979. – reference: 1) Alnaif, N., et al.: Diagnosis of isolated extensor carpi radialis longus (ECRL) tendon avulsion fracture using ultrasound: a paradigm shift. Skeletal Radiol., 47: 1289-1292, 2018. – reference: 6) Ghani, Y., Sharma, P. R., Grant, L.: Non-surgical management of an avulsion fracture injury of extensor carpi radialis brevis. Hand Surg., 18: 97-98, 2013. – reference: 8) Jessa, K. K., Hodge, J. C.: Avulsion fracture of tendon of extensor carpi radialis longus: unknown mechanism. J. Emerg. Med., 15: 201-207, 1997. – reference: 13) Shyamsundar, S.: Avulsion fracture of the extensor carpi radialis longus tendon: case report and literature review. Hand Surg., 17: 247-249, 2012. – reference: 17) Vandeputte, G., De Smet, L.: Avulsion of both extensor carpi radialis tendons: a case report. J. Hand Surg. Am., 24: 1286-1288, 1997. – reference: 3) Clark, D., et al.: Extensor carpi radialis longus avulsion: a literature review and case report. Hand Surg., 13(3): 187-192, 2008. – reference: 2) Cassell, O. C., Vidal, P.: An unreported cause of rupture of the extensor pollicis longus tendon. J. Hand Surg. Br., 21: 640-641, 1996. – reference: 14) Takami, H., Takahashi, S., Ando, M.: Avulsion fracture of the second metacarpal base by the extensor carpi radialis longus. Arch. Orthop. Trauma Surg., 118: 109-110, 1998. – reference: 15) Treble, N., Arif, S.: Avulsion fracture of the index metacarpal. J. Hand Surg. Br., 12: 38-39, 1987. – reference: 18) 吉川泰弘ら：第2中手骨基部裂離骨折3例の治療経験．臨整外，32: 645-648, 1997. – reference: 12) Robert, N., et al.: Avulsion fracture of the extensor carpi radialis longus carpal insertion due to a basketball injury: case report and literature review. Chir. Main., 33: 410-412, 2014. – reference: 9) Mcinnes, J. D.: Avulsion fracture of the base of the second metacarpal. Can. Med. Assoc. J., 57: 379, 1947. – reference: 7) Jena, D., Giannikas, K. A., Din, R.: Avulsion fracture of the extensor carpi radialis longus in a rugby player: a case report. Br. J. Sports Med., 35: 133-135, 2001. – reference: 16) 牛島貴宏ら：橈側手根伸筋腱付着部裂離骨折の治療経験．臨整外，50: 817-821, 2015. – reference: 4) Crichlow, T. P., Hoskinson, J.: Avulsion fracture of the index metacarpal base: three case reports. J. Hand Surg. Br., 13: 212-214, 1988. – reference: 10) Najefi, A., et al.: Avulsion fractures at the base of the 2(nd) metacarpal due to the extensor carpi radialis longus tendon: a case report and review of the literature. Arch. Trauma Res., 5: e32872, 2016. – reference: 11) Punjabi, V., Leong, A.: Avulsion fracture of the base of the index metacarpal by extensor carpi radialis longus: a case report. Int. J. Orthop. Surg., 9-2, 2007. |
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| Title | 長橈側手根伸筋裂離骨折後偽関節の1例 |
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