Avulsion fracture of the base of the index metacarpal by extensor carpi radialis longus: A Case Report

摘要

Avulsion fracture of the base of the second metacarpal is an uncommon injury because of the stability of the carpometacarpal joints. We present a case of fracture of the index metacarpal base with avulsion of the extensor carpi radialis longus tendon. All the previous reports have described fall on flexed wrist as mechanism of injury. This case represents the injury as a result of motor vehicle accident (dashboard injury). It was treated with open reduction and internal fixation using a screw and suture anchor. After surgery, the patient regained full function with normal range of movement and power of the wrist. Case Report A 47 year old lady was involved in a motor vehicle accident. She was the driver of a car which had a head on collision. She sustained a hyperflexion injury to the left (dominant) wrist which hit the dashboard of the car. She did not sustain any other injuries. She presented to the emergency department with a painful and swollen dorsum of left hand. Clinical examination revealed swelling and tenderness over the base of the index metacarpal. Extension of the wrist was very painful and limited. There was no soft tissue swelling in the extensor muscle mass proximally in the forearm. The skin was not breached and the injured hand was neurovascular intact. Radiographs revealed an avulsion fracture of the base of the index metacarpal on the radial side (Fig.1).