Fabio Catalano, Luigi Giulio Conforti, Davide Ciclamini, Francesca Mosetto, Pier Luigi Tos
Reconstructive Microsurgery Unit - Orthopedic Department - Trauma Center - CTO Hospital – Via Zuretti 29, Torino, Italy
SINTESI
Un paziente di 33 anni giungeva presso il nostro ambulatorio lamentando dolore al polso destro. In anamnesi riferiva una ferita alla mano destra causata dal vetro di un’automobile a causa di un incidente
stradale circa tre anni prima. L’esame radiografico e la risonanza magnetica del polso destro mostravano corpi estranei descritti come “vitrei” localizzati tra la fibrocartilagine triangolare e l’osso piramidale .
L’esame artroscopico ha evidenziato un frammento di vetro a livello dell’articolazione radio-carpica ed
una conseguente lesione focale al complesso della fibrocartilagine triangolare. Tramite la rimozione del
frammento ed un’accurata sinoviectomia si è ottenuta la risoluzione della sintomatologia. Parole chiave: corpo estraneo, vetro, artroscopia, articolazione radio-carpica
SUMMARY
A 33-years-old man arrived to our observation with pain at his right wrist. He referred a car glass single wound of right hand in anamnesis three years before. X-ray and magnetic resonance imaging showed
loose bodies described as vitreous foreign body, located between triangular fibrocartilage complex
sur-face and triquetrum bone. Arthroscopy revealed an unusual glass foreign body in radio-carpal joint and
related focal damage of triangular fibrocartilage complex. Removal of body and synovectomy induced
regression of symptoms.
Keywords: foreign body, glass, arthroscopy, radio carpal joint
Referente
Catalano Fabio, Via Marco Polo, 425 - Messina - Tel. +39 3805175845 - E-mail: fabio02@email.it
INTRODUCTION
Loose bodies in the wrist joint are an uncommon cause of wrist pain and locking. An unusual
ar-throscopic finding of a vitreous foreign body in
ra-dio-carpal joint is described.
CASE REPORT
A 33-years-old man arrived to our observation com-plaining of a four years history of right wrist pain. His clinical history revealed a right wrist car glass wound without any bone, tendinous, vascular or nervous involvement three years before and a right wrist fracture that had occurred accidentally during a football match, treated with plaster bandage about two years before.
The patient began to feel wrist pain on the volar and
ulnar surface after the first trauma. He described
a discontinuous and sharp pain, exacerbated dur-ing loaddur-ing activity, swimmdur-ing and guitar playdur-ing. Clinical examination showed partial wrist locking and painful pronation, grip strength was 90% com-pared to the unaffected wrist. X-ray and MR imaging showed a possible presence of a fragment of glass between the TFCC surface and the triquetrum bone (Fig. 1 A-B). Wrist arthroscopy was the technique of choice to treat this problem.
Wrist arthroscopy showed up a triangular shaped fragment of glass of about 5x2x1 mm, located in the radio-carpal joint (Fig. 2 A-B). It had caused
fibrocar-Chirurgia della Mano - Vol. 51 (2) 2014 Casi Clinici
74 Fabio Catalano, Luigi Giulio Conforti, Davide Ciclamini, Francesca Mosetto, Pier Luigi Tos
tilage complex (TFCC) without ligament rupture and widespread synovitis of the ulnar compartment. The scapho-lunate and luno-triquetral ligament did not show any alteration. Glass fragment removal and synovectomy were performed. Early motion was started post-operatively to limit adhesions. The patient obtained pain relief some days later and one
year follow up confirmed total recovery of wrist
mo-bility.
DISCUSSION
Wrist arthroscopy is a well established method to di-agnose and treat wrist disorders. Loose bodies found
in the wrist joint cavity are rare and they usually have chondral or osseous origin. Reviewing litera-ture, the main location is the pisotriquetral joint [1], the radio-carpal joint has been involved in 3 cases, the mid-carpal joint in 1 case and the DRUJ in 1 case as well [2-3]. To our knowledge, there is no report in literature about a glass foreign body in the wrist joint, but related articular damage can be compared to defects induced by loose bodies. As referred by Koh et al. [4], locking is thought to be a character-istic symptom of loose bodies, while pain on the ulnar-side of the wrist is often correlated to TFCC damage. Articular defects often go undetected by
Figura 1. A) X-ray image of
su-spected foreign glass body betwe-en TFCC surface and triquetrum bone.
B) MR image of suspected foreign glass body between TFCC surface and triquetrum bone.
Figura 2. A) Arthroscopic image
of glass fragment located in the radio-carpal joint
B) Removed triangular shape glass fragment, about 5x2x1 mm.
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A glass foreign body in radio-carpal joint: an unusual case
pre-operative imaging studies and they are best seen at the time of arthroscopy. Wrist chondral lesions
have been classified by Culp et al. [5]: debridement
and synovectomy are the recommended treatment
for chondral fibrillation and fissuring, as described
in our case report. Pain and locking relief is obtained after arthroscopic removal of the loose body and synovectomy.
REFERENCES
1. Steinman SP, Linscheid RL. Pisotriquetral loose bodies. J Hand Surg 1997; 22: 918-921.
2. De Smet L, Van Wetter P. Synovial
chondroma-tosis of the distal radio-ulnar joint. Acta Orthop Belgica 1987; 53: 106-108.
3. Zachee B, De Smet L, Fabry G. A snapping wrist due to a loose body: Arthroscopic diagnosis and treatment. Arthroscopy 1993; 9: 117-118. 4. Koh S, Nakamura R, Horii E et al. Loose body in
the wrist: diagnosis and treatment. Arthroscopy 2003; 19: 820-824.
5. Culp RW, Osterman AL, Kaufmann RA. Wrist arthroscopy: operative procedures. In: Green DP, Hotchkiss RN, Pederson WC, Wolfe SW, eds. Green’s Operative Hand Surgery, 5th ed. Else-vier, Philadelphia, 2005, pp. 781-803.
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