Case Report Osteochondral Fragment—A Rare Cause of Locked Metacarpophalangeal Joint英文文献资料.docVIP

Surgical Science, 2011, 2, 353-355 doi:10.4236/ss.2011.26076 Published Online August 2011 (http://www.SciRP.org/journal/ss) Case Report: Osteochondral Fragment—A Rare Cause of Locked Metacarpophalangeal Joint Kelvin Ramsey, S. Overstall, A. Fleming St. George’s Hospital, London, UK E-mail: kwdr@ Received April 1, 2011; revised May 2, 2011; accepted July 14, 2011 Abstract We describe the presentation of a patient with sudden, sharp pain associated with a snapping sensation, swelling and pain over the metacarpophalangeal joint (MCPJ) with no history of direct trauma. The finger was held in 30 degrees of flexion and significantly deviated to the ulnar side with loss of extension. A diag- nosis of traumatic rupture of the radial sagittal band of the extensor mechanism was made but the cause at exploration was found to be impingement of an osteochondral fracture fragment. This is a rare cause of irre- ducible loose body “locking” of the metacarpophalangeal joint. Keywords: Metacarpophalangeal Joint, Locking, Osteochondral, Fragment 1. Introduction sible. The extensor mechanism was explored using a curvilinear incision over the dorsum of the MCPJ. The extensor tendon was found to lie perfectly in the midline and the sagittal bands were intact. The volar aspect of the finger (over the A1 pulley) was exposed to exclude an impacted trigger finger. A small incidental flexor sheath ganglion was found and excised but the flexor tendons were running freely prior to this. The MCP joint capsule was then opened and explored. Lying within the joint on the dorsal aspect of the meta- A 72 year old, right-handed female rheumatoid arthritis patient was referred to our department with an acutely painful, swollen left middle finger. One week prior to arrival she had picked up a kettle and noticed a sudden, sharp pain associated with a snapping sensation. The finger immediately became swollen and painful ove