徒手整復不能であった背側転位型基節骨骨頭骨折の1例

Irreducible Proximal Phalangeal Head Fracture. Case Report

　掌側板が整復阻害因子であった右中指基節骨骨頭骨折の1例を経験した．症例は12歳の女児で，突き指で受傷し近医で指ブロック下に徒手整復が行われたが，整復不能で当院を紹介され受診した．初診時単純X線像で掌側に第3骨片を有する背側転位型基節骨骨頭骨折を認め，観血的治療を行った．掌側進入で骨折部を確認すると，掌側板が整復阻害因子となっていた．本症例のように鳥嘴状の掌側骨片を有する背側転位型指節骨骨折では，掌側板が整復阻害因子となっている可能性があるため，無理な整復操作を行わずに観血的に整復固定を行うことが重要である．

　Proximal phalangeal head fracture of the finger is a relatively uncommon injury in children and usually can be successfully treated by closed reduction.　We report the case of a patient with an irreducible proximal phalangeal head fracture that required open reduction.　A 12-year-old girl sustained the proximal phalanx head fracture of a her middle finger.　The fracture could not be reduced by closed manipulation and required open reduction.　Volar approach revealed that the volar plate was interposed between the displaced fragments.　This case is a reminder that an interposed volar plate should be suspected as a cause of an irreducible phalangeal head fracture with a beak fragment.