整形５９

【臨床症状】30代　転倒受傷

【問題】画像所見と診断名は？

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    ▶答えはこちら
    • 橈骨頭に関節面に達する骨折線を認める
    • 骨片の転移は認めない
    • 上記より橈骨頭骨折（Masson-Morry分類Type1）と診断できる
    • 少量の関節血種と皮下気腫あり

    【橈骨頭骨折】

    ・肘を軽度屈曲し、前腕回内位で手をついて転倒した時に、上腕骨小頭からの対軸方向の圧力によって骨折する

    ・橈骨頭の前外側縁に多く、成人の肘骨折のうち30％を占める

    ・中年の女性に多いと言われている

    ・単純写真では見逃されやすい骨折の一つ

    ・Fat pad signがあると骨折を疑うべきサインになる

    <fat pad sign>

    • 骨折等により血種や液体貯留によって、関節周囲の脂肪組織が圧迫されて描出されるもの
    • 単純X線で確認する

    橈骨頭骨折にはMason-Morry分類が用いられる事が多い

    <Mason-Morry分類>

    • Type1　転位なし
    • Type2　転位あり
    • Type3　粉砕骨折
    • Type4　合併損傷（尺骨鈎状突起骨折、肘頭骨折、側副靭帯損傷など）

    参考書籍：骨軟部疾患の画像診断 第2版