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Case Report: Oblique Fracture of the Ulnar Sesamoid Bone of the Metacarpophalangeal Joint, a Rare Pathology.

ABSTRACT: Fractures of the sesamoid bones of the metacarpophalangeal joint (MCPJ) are a rare pathology in hand trauma. Only a few case reports and case series were found in literature. The diagnosis of an ulnar sesamoid bone fracture of the MCPJ is difficult and can pose a differential diagnostic problem with Stener lesions or ulnar collateral ligament (UCL) instability. This pathology is frequently missed with subsequent poor functional outcomes. Correct and early diagnosis is important as this will allow for correct treatment with full recovery of function without sequelae.We report a case of a 35-year-old male Caucasian patient after a thumb injury due to a fall with his mountain bike. X-ray showed a fracture of the ulnar sesamoid of the MCPJ of the pollex, which is rarely reported in this literature. Anamnesis, clinical examination, and X-ray evaluation contributed to our diagnosis. The ulnar sesamoid bone fracture of the MCPJ of the right pollex was initially treated conservatively with immobilization, rest and ice application. After 3-4 weeks, physiotherapy with thenar muscles exercises was started. 10 weeks after the injury, our patient reported a total recovery of function and pain-free thumb movement during daily activities.Ulnar sesamoid fractures are rarely reported in current literature. This type of injury should be recognized as early as possible since it can be easily missed. Then a benign course can be expected after short immobilization of the MCPJ of the thumb during circa 2 weeks. UCL instability or a Stener lesion should be excluded at the emergency department by performing an ultrasound. With this case report, we underline the importance of early diagnosis and exclusion of an unstable Stener lesion.

SUBMITTER: Jan D

PROVIDER: S-EPMC5553830 | biostudies-other | 2017 Mar-Apr

REPOSITORIES: biostudies-other

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Project description:RationaleHabitual volar dislocation of the ulnar head with a locked distal radioulnar joint (DRUJ) is a rare complication after distal radius fracture. We present a case of habitual volar dislocation of the ulnar head in a woman with a dorsally displaced malunited distal radius fracture.Patient concernsA 72-year-old woman presented with occasional painful locking of the forearm in full supination. She had fractured the left distal radius in a fall 6 months previously. The fracture had been treated non-surgically with wrist immobilization in a long and short arm cast for 6 weeks. Physical examination showed no swelling of the left hand. The wrist locked when the forearm was fully supinated, and the patient was not able to pronate her forearm without reducing the ulna by pressing the left ulna down toward the DRUJ. She experienced sharp pain during the reduction procedure and pronation of the left forearm. The affected wrist had 91% motion compared with the contralateral wrist.DiagnosisRadiography and computed tomography showed 28° dorsally angulated malunion of the distal radius and ulnar head subluxation with respect to the radius. Magnetic resonance imaging revealed disruption of the ulnar-side triangular fibrocartilage complex (TFCC) from the ulna fovea.InterventionsThe patient desired surgery to address the painful click during full supination of her left wrist and the limitations in her activities of daily living. Corrective osteotomy of the distal radius and arthroscopic repair of the ulnar-side tear of the TFCC were performed. The TFCC was arthroscopically repaired to the ulnar fovea to stabilize the DRUJ.OutcomesAt 1 year postoperatively, radiography showed complete union of the radius. The affected side had 97% wrist motion compared with the contralateral wrist and a full range of forearm rotation without pain or clicking. The grasp strength was 100% compared with the normal wrist.LessonsMalunited distal radius fracture with concomitant TFCC injury can result in habitual volar dislocation of the ulnar head due to severely dorsally angulated malunion of the radius and avulsion of the ulnar-side TFCC from the ulna fovea. This condition required corrective osteotomy plus TFCC repair.

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Case Report: Oblique Fracture of the Ulnar Sesamoid Bone of the Metacarpophalangeal Joint, a Rare Pathology.

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