Severe Complications Resulted from Delayed Diagnosis of Transscaphoid Perilunate Fracture Dislocation

腕關節是決定手功能正常表現的樞紐角色，任何被忽略而未接受治療的傷害，皆會對手功能造成程度不等的影響。事實上，被忽略的腕關節傷害並不少見；而其中以舟狀骨及月狀骨相關的骨折脫臼發生機率最高。因為舟狀骨及月狀骨乃構成腕關節關節面的主要部份，也是活動度最高的腕骨。本文提出三例因被忽略的舟狀骨及月狀骨骨折或脫臼，而造成嚴重的手部功能限制及伴隨的壓迫性正中神經病變，經由開放性復位合併內固定及其他補償性手術，雖仍有部分腕關節功能的限制，但他們皆對手術結果感到滿意，並且能夠使用受傷的手以勝任日常生活甚至原來的工作。因此我們認為：對腕關節受傷的早期診斷及積極治療，方能減少日後的手功能障礙；即使缺乏明確的臨床徵候，仔細的理學評估及適當的影像學檢查皆可獲得正確診斷。

關鍵字

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並列摘要

Neglected wrist injury is not uncommon, and the transscaphoid perilunate fracture dislocation may occupy significant portion of them. We encountered three such cases recently presenting with severe restriction of wrist function, hand contracture and compresive median nerve neuropathy. Those disastrous complications resulted from neglected trannsscaphoid perilunate fracture dislocation were resolved by open reduction and internal fixation, reverse radial forearm flap, release of the carpal tunnel or proximal carpectomy. All of them finally got significant improvement of hand function, and they can use the hand for daily activity and even original occupation. Early diagnosis and aggressive treatment of carpal bone injuries should be emphasized to avoid further functional sequelae. Even when there is inconspicuous signs of carpal bone injury, cautious physical examination and various imaging studies should be able to provide correct diagnosis. However, the ability to identify any pathological finding on imaging studies had better to be mastered.

並列關鍵字

transscaphoid perilunate fracture-dislocation ； proximal carpectrmy

國際替代計量

Severe Complications Resulted from Delayed Diagnosis of Transscaphoid Perilunate Fracture Dislocation

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