Dorsal approach for isolated volar fracture-dislocation of the base of the second metacarpal:A case report

BACKGROUND We report a case with the displacement of an articular fracture fragment of the base of the second metacarpal from the ulnar to the volar side,treated via the dorsal approach.The dorsal approach can be a good option not only because it allows direct observation of ligament damage and fixation of bone fragments but also because the thin subcutaneous tissue makes the approach easier.CASE SUMMARY A 45-year-old man with a right hand injury visited the hospital.A small bone fragment was identified using plain radiography.Lateral radiography revealed the fragment as lying over the volar aspect of the carpometacarpal(CMC)joint.Computed tomography revealed that approximately one-third of the CMC joint surface of the second metacarpal was damaged.We provisionally diagnosed an intra-articular fracture with significant CMC joint instability and performed open reduction and internal fixation.We made a dorsal longitudinal incision over the CMC joint between the second and third metacarpals.The dorsal ligament of the third CMC joint was torn.We thought it had been dislocated to the volar side and spontaneously reduced to that position.There are only few reports of volar dislocation of CMC joint fractures,particularly of the second and third metacarpals;our report is unique as our patient had an intact interosseous ligament between the second and third metacarpals.CONCLUSION Although past reports have used a palmar approach,the dorsal approach is a good option for these cases.

Intracortical chondroma of the metacarpal bone:A case report

BACKGROUND Intracortical chondroma of the metacarpal bone which could be painful is an extremely rare condition and previously only one case has been reported.Due to the similar physical features and appearance on clinical imaging,it is difficult to differentiate between intracortical chondroma and osteoid osteoma.Therefore,pathological examination is usually required to establish a definite diagnosis,which is often carried out only after tumor removal.In this study,we describe a case of intracortical chondroma which developed in the metacarpal bone and demonstrate the utility of magnetic resonance imaging(MRI).CASE SUMMARY We present a case of a 40-year-old man with intracortical chondroma of the metacarpal bone who was strongly suspected of having a tumor,and it was confirmed using contrast-enhanced MRI and successfully treated with curettage.MRI performed before tumor removal revealed signal intensity similar to that of the nidus of an osteoid osteoma.However,no abnormal intensity was observed in the bone or soft tissues surrounding the tumor.Such abnormalities on images would indicate the presence of soft-tissue inflammation,which are characteristics of osteoid osteoma.Furthermore,contrast-enhanced imaging revealed no increased enhancement of the areas surrounding the tumor.This is the first report to describe the contrast-enhanced MRI features of intracortical chondroma.This may serve as a guide for clinicians when intracortical chondroma is suspected.CONCLUSION The contrast-enhanced MRI was useful for the differential diagnosis of intracortical chondroma.

Clinical application of the second metacarpal bone lateral needling

Objective： To explore the rules of the second metacarpal bone lateral needling in clinical application and its characteristics so as to provide the guidance to clinical practice.Methods： Taking ＂the second metacarpal holographic acupuncture therapy＂ ＂the second metacarpal bone lateral needling＂ and ＂the second metacarpal bone＂ as the search terms, the papers on the second metacarpal bone lateral needling were retrieved from China National Knowledge Infrastructure（CNKI）and Wanfang database from January 1, 1974 to December 31, 2016 and were screened. Using the Excel2003, the database of the diseases treated by the second metacarpal bone lateral needling was set up.The indications, the acupoints selection rules and needling manipulation of this therapy were analyzed.Results： A total of 1103 papers were retrieved, of which, 446 papers were from CNKI and 657 from Wanfang database. According to the inclusion and exclusion criteria, 54 papers were included for analysis finally. It was found that the indications of the second metacarpal bone lateral needling were predominated by the soft tissue injuries, especially acute lumbar sprain, ankle sprain and knee joint injury. Regarding the acupoints selection rules of the second metacarpal bone lateral needling, the corresponding points and tender points were commonly selected. Regarding the needling manipulation, the strong stimulation was required after needle insertion and the patient was required to move the affected areas while keeping the strong needling sensation. The needles were inserted 20 mm in depth along the skin mainly.The even-needling technique was exerted and the needles were retained for 30 min mainly.Conclusion： The second metacarpal bone lateral needling is applied to the treatment of soft tissue injuries. It is applicable for some internal diseases. The strong needling sensation and the motion of the local affected area are required especially in treatment with this therapy.