Isolated fracture of the trapezium is an uncommon injury accounting for only 35% of all carpal fractures. The trapezium is the most mobile bone of the distal carpal row. As these injuries are often imperceptible on plain radiographs, diagnosis in the ed setting is challenging. The trapezium also known as the greater multangular is one of the eight carpal bones of the hand. The distal radius articulates with the bones of the proximal carpal row except the pisiform and triquetrum at the radiocarpal joint. Management of combined open fractures of thumb metacarpal and. Many carpal injuries are benign needing little or no immobilisation.
To date, few articles have been published on isolated trapezoid fractures. This paper presents a case of an isolated dislocation of the trapezium without fracture, managed with closed reduction and percutaneous wiring. Combined bennett fracture dislocation and trapezium. Vertical sagittal split fractures of the body of trapezium occur rarely in isolation and accounts for 20% of these fractures. There are two types of fracture of the ridge of the trapezium.
Isolated trapezium fracture in combination with thumb carpometacarpal cmc joint dislocation is extremely rare, and no treatment consensus exists. Triquetrum fractures typically occur from a fall onto an outstretched arm with the wrist in extension and ulnar deviation, or in extreme flexion 5. It may be a sign that your fracture is not healing if you notice decreased strength, such. Traumatic isolated trapezium dislocation without fracture. Bennetts fracture associated with fracture of trapezium a. The trapezium is the third most common type of carpal fracture with an incidence of 6 % of all. The fracture of the proximal pole of the scaphoid was only found on computed tomography imaging. There has been no case of simultaneous fracture of the trapezium and the proximal pole of the scaphoid. The trapezium is an irregularshaped carpal bone found within the hand. The trapezium has a slightly concave articulation with the scaphoid, and a flat facet articulation with the trapezoid. Postoperative management of carpometacarpal joint fracture. Closed fracture of trapezium bone larger multangular of wrist.
The lunate acts as a central anchor for the carpal bones. Sep 19, 2014 the lunate acts as a central anchor for the carpal bones. The authors report and discuss the management of a 25yearold male patient with a trapeziometacarpal joint dislocation complicated by a trapezium fracture. Pdf trapezium fractures are rare injuries which should not be missed. I am in a hard wrist splint with thumb keeper now only removed for showering. Fractures of the trapezium constitute 15% of all the carpal fractures and are the third most common carpal fractures encountered. If the fracture is in a certain part of the bone or if the fracture is at all displaced bone ends have shifted, surgery might be the best option. Those that require surgery usually do great after surgery. Our patient presented to us late, following treatment for a ligament. They can be broadly classified into ridge most common 2 and body fractures. Hand therapy, consisting of protective splinting and activeassisted rom, was initiated eight weeks following injury figure 4. Offer surgical and nonsurgical treatment options for each carpal fracture. Management of an unusual injury of combined open fractures of the first metacarpal shaft and trapezium due to crush injury in a 21yearold man was reported in this paper.
Options for treating fractured trapezium healthboards. While good shortterm results have been reported in the literature, the possibility of substantial ligament injuries that can lead to. Open fractures require immediate iv antibiotics and urgent surgical washout. Surgical treatment of intraarticular fractures of the trapezium. It articulates with the scaphoid proximally, the trapezoid medially, and the thumb and index metacarpals distally. Trapezium fracture a common technique to fix a rare. Trapezium fracture associated with thumb carpometacarpal joint. Nonunion is the most common complication after scaphoid fracture treatment, and it may occur in as many as 510% of cases despite proper treatment. The trapezium and trapezoid are collectively known as the. Shearing forces exerted by the proximal hamate, distal ulna, or both may play a role.
The trapezium is one of the small carpal bones its at the base of the thumb. Trapezium fractures are rare injuries which should not be missed. Sesamoiditis is painful inflammation of the sesamoid apparatus, which is located in the forefoot most patients will describe a deep achy and sharp pain in the ball of the foot behind the big toe with every step taken. If the scaphoid fracture is not healing, you may or may not continue to have symptoms.
There is a wide spectrum of carpal injuries, from minor to complex. Or is the splint a safe option and will it heal as well. However, they are very important fractures to detect and treat early given the importance of the trapezium in the carpometacarpal joint in actions such as grip and pinch. The purpose of this article is to document and discuss the surgical treatment performed to a 34yearold man who sustained a closed isolated vertical split fracture of the trapezium on his left nondominant hand. Sep 26, 2019 nonunion is the most common complication after scaphoid fracture treatment, and it may occur in as many as 510% of cases despite proper treatment. Discuss important neurovascular considerations blood supply etc. Fracture proximal to the perforating vessels on the dorsoradial surface of the scaphoid can cause significant bone ischemia of the proximal pole. Factors predictive of this complication include smoking, longer time elapsed since the fracture, and avascular necrosis avn of. I had a fall with my left arm outstretched and that resulted in a hairline fracture.
Treatment depends on the degree of displacement and other associated injuries and ranges from activity modification or immo bilization to open. Fractures of trapezium are very rare accounting for about 0. In this paper, we reported a case of a 64yearold man with isolated trapezium fracture due to a motorcycle accident. Isolated fractures of the trapezium are only thought to account for 35% of all carpal fractures 12.
Delayed diagnosis, inadequate initial management, proximal fracture location, osteonecrosis,andassociatedcarpalinstability with acute scaphoid fracture can lead to nonunion of the scaphoid. Trapezium fractures account for 3%5% of all carpal fractures, 8. Key words carpal fracture, hamate, lunate, trapezium, triquetrum. Trapezium fracture is not commonly seen after fall on an outstretched hand. Neurovascular compromise from fracture requires emergent reduction andor orthopedic intervention. As with all phalangeal fractures, alignment is key in fracture management is to prevent rotational malalignment tips. Trapezium fracture a common technique to fix a rare injury. Diagnosis and management of scaphoid fractures american. We report a case of an isolated fracture of the trapezium which was picked up as a nonunion 5 months after the injury following persistence of symptoms. Being predominantly articular, the blood supply to the scaphoid has limited access. This type of fracture occurs most often after a fall onto an outstretched hand. Factors predictive of this complication include smoking, longer time elapsed since the fracture, and avascular necrosis avn of the proximal fragment. Isolated coronal fracture of the trapezium is rare and accounts for only 35% of all carpal fractures 1. Mar 23, 2007 either the fracture of carpal trapezial bone or the fracture of thumb metacarpal shaft is less common than usual, 5, 8, and fractures of trapezium are frequently associated with other carpometacarpal injuries 3, 5.
The management of these cases has varied from complete excision to open or closed reduction, with or without percutaneous wiring. Several methods have been described in the literature for treatment of this rare fracture, from conservative treatment in plaster to open reduction and internal fixation orif 5. A rare case of isolated trapezium fracture in motorcycle polytrauma. Mar 23, 2007 management of an unusual injury of combined open fractures of the first metacarpal shaft and trapezium due to crush injury in a 21yearold man was reported in this paper. Most heal without surgery without resulting in significant residual pain andor dysfunction. Fractures of the trapezium are rare and easily missed. He had a bennett fracture with a vertical trapezium fracture. Fractures of the trapezium most commonly occur at the trapezial ridge, fig 10. Closed fracture of trapezium bone larger multangular of wrist short description. We performed accurate reduction and fixation of both fractures with cannulated headless compression screws in a minimally invasive. Most frequent management and treatment of trapezial fractures can be carried from nonoperative techniques7, 9 thumb immobilisation in a.
A scaphoid nonunion fracture refers to a wrist fracture that is failing to heal. As an alternative management option for the comminuted combined open fractures of thumb metacarpal and trapezium, we hereby present such a. This injury is more challenging to manage than an isolated bennetts fracture as anatomical reduction of the trapezium with reduction of the first cmc is needed. Isolated dislocation of the trapezium is an uncommon injury. Introduction summary about significance of fracture including epidemiology. A rare case of isolated trapezium fracture in motorcycle. Scaphoid fracture is a common injury encountered in family medicine. To avoid missing this diagnosis, a high index of suspicion and a thorough history and physical examination are nec. In treating a fracture, the objectives of the treatment are as follows. The trapezial ridge is a vertical prominence on the volar aspect of the trapezium, where ligaments and the flexor. Approach to isolated trapezoid fractures ochsner journal. He was treated with kwire fixation without a capsulotomy.
It is the most lateral radial bone of the distal row, located between the scaphoid and the first metacarpal bone. Mechanisms of injury have typically been reported as an axial load, with or without forced wrist flexionextension, that is transmitted from the second metacarpal indirectly to the trapezoid. Isolated trapezium fracture in combination with thumb carpometacarpal cmc joint dislocation is extremely rare, and no treatment consensus. Management of combined open fractures of thumb metacarpal. We report a case of a 27yearold right hand dominant man who sustained a closed vertical trapezium fracture and first carpometacarpal joint dislocation which was treated with closed reduction and percutaneous kirschnerwire fixation, a technique familiar to all orthopaedic surgeons. As an alternative management option for the comminuted combined open fractures of thumb metacarpal and trapezium, we. Trapezium fractures are very rare and can lead to significant deficit of hand function if missed. Jun 19, 2016 there are two types of fracture of the ridge of the trapezium. May 02, 2014 the trapezium is one of the small carpal bones its at the base of the thumb. However, they should not be missed because inadequate treatment of trapezium fractures can lead to permanent impairment based on the. This might include the insertion of a screw or pins figure 3.
Trapezium fracture associated with thumb carpometacarpal. It is situated at the radial side of the carpus, between the scaphoid and the first metacarpal bone the metacarpal bone of the thumb. The carpal bones are bound to each other by short intercarpal ligaments for example, the scapholunate and the triquetrolunate. A fracture that is healing more slowly than expected is a delayed union fracture. Surgical management included irrigation, debridement, and reduction of the first metacarpal fracture followed by external fixation extending from the first metacarpal to the. Symptoms typically include pain and tenderness below the base of the thumb in an area known as the anatomic snuffbox. A case report timothy bell md, shrikant j chinchalkar mtho bsc ot otr cht, kenneth faber md mhpe frcsc hand and upper limb centre, st josephs health care, london, ontario. A scaphoid fracture is a break in one of the small bones of the wrist. Herein, we report 3 successfully treated cases of isolated trapezium fracture with thumb cmc joint dislocation. In the printed or pdf version of this article, author affiliations can be found at the. Surgical treatment of intraarticular fractures of the. In a transtrapezium fracturedislocation the body of the trapezium is usually split vertically 4. It is homologous with the first distal carpal of reptiles and amphibians surfaces. Bennetts fracture associated with fracture of trapezium.
Standard ap, lateral, and oblique radiographs should be obtained initially to visualize the osseous structures of the wrist. Pdf trapezium fracture a common technique to fix a rare injury. Doctor answers on symptoms, diagnosis, treatment, and more. Isolated coronal fracture of trapezium a case report with. We report a case of a young adult male who presented with such an injury after a motor vehicle accident. The patient was treated at our orthopaedic surgery department. In addition, either the dorsal or volar radiotriquetral ligaments may avulse triquetral fragments at their.
Fractures of the trapezium are uncommon, comprising between 3% to 5% of all carpal fractures. Thus, fracture of trapezium associated with a bennetts fracture is a rare injury and if ignored it may lead to poor results. There are sixteen cases to date reported in the literature. Trapezium fractures are uncommon carpal bone injuries. The scaphoid fractures present some of the greatest dilemmas in management of hand fractures. No consensus exists regarding optimal treatment for this rare injury. Association of fracture of the trapezium with bennetts fracture is very rare and makes reduction and stabilisation more difficult. Closed fracture of trapezium bone larger multangular of. Open reduction and fixation of trapezium fracture medcrave. Surgical management included irrigation, debridement, and reduction of the first metacarpal fracture followed by external fixation extending from the first metacarpal to the distal radius and primary wound closure. Trapezium fracture associated with occult fracture of the. The combination of bennett fracture dislocation and trapezium fracture is rare and presents a diagnostic and therapeutic challenge. Fell 121511, small fracture of trapezium was not diagnosed till 123011. It will be difficult to perform many weight bearing activities.
Cureus combined bennett fracture dislocation and trapezium. The trapezium is distinguished by a deep groove on its anterior surface. The trapezoid is the least commonly fractured carpal bone, comprising 4% of all carpal fractures. Postoperative management of carpometacarpal joint fracture dislocation of the hand.
421 926 239 1028 1102 619 1010 1522 1544 272 92 1224 1104 59 1394 1207 1338 18 1174 658 1239 1423 18 609 1042 1159 589 1000 1215 1070 630 1493 977 1345 824 728 424 1164 417 628 1371 482 192 967 396 627 1363 1425