Key words carpal fracture, hamate, lunate, trapezium, triquetrum. Isolated fracture of the trapezium is an uncommon injury accounting for only 35% of all carpal fractures. Doctor answers on symptoms, diagnosis, treatment, and more. 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. Herein, we report 3 successfully treated cases of isolated trapezium fracture with thumb cmc joint dislocation. Trapezium fractures are rare injuries which should not be missed. 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. 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. The patient was treated at our orthopaedic surgery department. The trapezium and trapezoid are collectively known as the.
Isolated trapezium fracture in combination with thumb carpometacarpal cmc joint dislocation is extremely rare, and no treatment consensus exists. Fractures of the trapezium most commonly occur at the trapezial ridge, fig 10. Fractures of the trapezium constitute 15% of all the carpal fractures and are the third most common carpal fractures encountered. The trapezium is one of the small carpal bones its at the base of the thumb. The scaphoid fractures present some of the greatest dilemmas in management of hand fractures. While good shortterm results have been reported in the literature, the possibility of substantial ligament injuries that can lead to. Or is the splint a safe option and will it heal as well. As these injuries are often imperceptible on plain radiographs, diagnosis in the ed setting is challenging.
A rare case of isolated trapezium fracture in motorcycle polytrauma. To date, few articles have been published on isolated trapezoid fractures. It is the most lateral radial bone of the distal row, located between the scaphoid and the first metacarpal bone. There is a wide spectrum of carpal injuries, from minor to complex. Open reduction and fixation of trapezium fracture medcrave. It articulates with the scaphoid proximally, the trapezoid medially, and the thumb and index metacarpals distally. Fractures of trapezium are very rare accounting for about 0. Combined bennett fracture dislocation and trapezium. No consensus exists regarding optimal treatment for this rare injury. Our patient presented to us late, following treatment for a ligament. Isolated coronal fracture of the trapezium is rare and accounts for only 35% of all carpal fractures 1. It is situated at the radial side of the carpus, between the scaphoid and the first metacarpal bone the metacarpal bone of the thumb. Hand therapy, consisting of protective splinting and activeassisted rom, was initiated eight weeks following injury figure 4.
They can be broadly classified into ridge most common 2 and body fractures. 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. Trapezium fracture a common technique to fix a rare. He was treated with kwire fixation without a capsulotomy. It has now been 10 weeks since i fell and has still not fully healed. Triquetrum fractures typically occur from a fall onto an outstretched arm with the wrist in extension and ulnar deviation, or in extreme flexion 5. I am in a hard wrist splint with thumb keeper now only removed for showering. It may be a sign that your fracture is not healing if you notice decreased strength, such. The trapezium is distinguished by a deep groove on its anterior surface. I had a fall with my left arm outstretched and that resulted in a hairline fracture. Closed fracture of trapezium bone larger multangular of.
The lunate acts as a central anchor for the carpal bones. The trapezium has a slightly concave articulation with the scaphoid, and a flat facet articulation with the trapezoid. In a transtrapezium fracturedislocation the body of the trapezium is usually split vertically 4. Trapezium fracture a common technique to fix a rare injury. Cureus combined bennett fracture dislocation and trapezium. This paper presents a case of an isolated dislocation of the trapezium without fracture, managed with closed reduction and percutaneous wiring. There are two types of fracture of the ridge of the trapezium. Nonunion is the most common complication after scaphoid fracture treatment, and it may occur in as many as 510% of cases despite proper treatment. Fell 121511, small fracture of trapezium was not diagnosed till 123011. 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. 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. 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.
Factors predictive of this complication include smoking, longer time elapsed since the fracture, and avascular necrosis avn of the proximal fragment. Isolated dislocation of the trapezium is an uncommon injury. However, they should not be missed because inadequate treatment of trapezium fractures can lead to permanent impairment based on the. Isolated trapezium fracture in combination with thumb carpometacarpal cmc joint dislocation is extremely rare, and no treatment consensus.
Trapezium fracture associated with thumb carpometacarpal joint. In this paper, we reported a case of a 64yearold man with isolated trapezium fracture due to a motorcycle accident. Discuss important neurovascular considerations blood supply etc. Delayed diagnosis, inadequate initial management, proximal fracture location, osteonecrosis,andassociatedcarpalinstability with acute scaphoid fracture can lead to nonunion of the scaphoid. This might include the insertion of a screw or pins figure 3. Sep 19, 2014 the lunate acts as a central anchor for the carpal bones. The trapezium is the most mobile bone of the distal carpal row.
To avoid missing this diagnosis, a high index of suspicion and a thorough history and physical examination are nec. Diagnosis and management of scaphoid fractures american. Trapezium fracture associated with occult fracture of the. He had a bennett fracture with a vertical trapezium fracture. Approach to isolated trapezoid fractures ochsner journal. Bennetts fracture associated with fracture of trapezium a.
Options for treating fractured trapezium healthboards. Many carpal injuries are benign needing little or no immobilisation. In the printed or pdf version of this article, author affiliations can be found at the. Association of fracture of the trapezium with bennetts fracture is very rare and makes reduction and stabilisation more difficult. Fractures of the trapezium are uncommon, comprising between 3% to 5% of all carpal fractures. Neurovascular compromise from fracture requires emergent reduction andor orthopedic intervention. The distal radius articulates with the bones of the proximal carpal row except the pisiform and triquetrum at the radiocarpal joint.
Fracture proximal to the perforating vessels on the dorsoradial surface of the scaphoid can cause significant bone ischemia of the proximal pole. The fracture of the proximal pole of the scaphoid was only found on computed tomography imaging. 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. 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 frequent management and treatment of trapezial fractures can be carried from nonoperative techniques7, 9 thumb immobilisation in a. Introduction summary about significance of fracture including epidemiology. Trapezium fractures account for 3%5% of all carpal fractures, 8. Those that require surgery usually do great after surgery.
A fracture that is healing more slowly than expected is a delayed union fracture. Shearing forces exerted by the proximal hamate, distal ulna, or both may play a role. Fractures of the trapezium are rare and easily missed. The carpal bones are bound to each other by short intercarpal ligaments for example, the scapholunate and the triquetrolunate.
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. Management of combined open fractures of thumb metacarpal. Standard ap, lateral, and oblique radiographs should be obtained initially to visualize the osseous structures of the wrist. Management of combined open fractures of thumb metacarpal and. May 02, 2014 the trapezium is one of the small carpal bones its at the base of the thumb. Most heal without surgery without resulting in significant residual pain andor dysfunction. Surgical management included irrigation, debridement, and reduction of the first metacarpal fracture followed by external fixation extending from the first metacarpal to the. Pdf trapezium fractures are rare injuries which should not be missed. We are reporting a rare case of bennetts fracture with fracture of the trapezium and subluxation of the carpometacarpal joint cmc joint, and describing a technique for successful reduction and stabilisation of these fractures.
Jun 19, 2016 there are two types of fracture of the ridge of the trapezium. 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. A rare case of isolated trapezium fracture in motorcycle. Scaphoid fracture is a common injury encountered in family medicine. This type of fracture occurs most often after a fall onto an outstretched hand. 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. As an alternative management option for the comminuted combined open fractures of thumb metacarpal and trapezium, we hereby present such a. There has been no case of simultaneous fracture of the trapezium and the proximal pole of the scaphoid. The combination of bennett fracture dislocation and trapezium fracture is rare and presents a diagnostic and therapeutic challenge. The trapezium is an irregularshaped carpal bone found within the hand.
Being predominantly articular, the blood supply to the scaphoid has limited access. Treatment depends on the degree of displacement and other associated injuries and ranges from activity modification or immo bilization to open. 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. A scaphoid fracture is a break in one of the small bones of the wrist. Surgical treatment of intraarticular fractures of the. Isolated coronal fracture of trapezium a case report with. 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.
We performed accurate reduction and fixation of both fractures with cannulated headless compression screws in a minimally invasive. Factors predictive of this complication include smoking, longer time elapsed since the fracture, and avascular necrosis avn of. Isolated fracture of the trapezium is often misunderstood for an incorrect radiological diagnosis and can lead to important deficit of hand function unless it was treated early 3. The trapezial ridge is a vertical prominence on the volar aspect of the trapezium, where ligaments and the flexor. Postoperative management of carpometacarpal joint fracture. Trapezium fracture is not commonly seen after fall on an outstretched hand. 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. Closed fracture of trapezium bone larger multangular of wrist. Trapezium fractures are uncommon carpal bone injuries. Closed fracture of trapezium bone larger multangular of wrist short description. As an alternative management option for the comminuted combined open fractures of thumb metacarpal and trapezium, we. Pdf trapezium fracture a common technique to fix a rare injury. The trapezoid is the least commonly fractured carpal bone, comprising 4% of all carpal fractures.
The trapezium is the third most common type of carpal fracture with an incidence of 6 % of all. A scaphoid nonunion fracture refers to a wrist fracture that is failing to heal. It is homologous with the first distal carpal of reptiles and amphibians surfaces. Trapezium fracture associated with thumb carpometacarpal. They can either occur in isolation or combination with another carpal bony injury.
The management of these cases has varied from complete excision to open or closed reduction, with or without percutaneous wiring. Offer surgical and nonsurgical treatment options for each carpal fracture. Thus, fracture of trapezium associated with a bennetts fracture is a rare injury and if ignored it may lead to poor results. As with all phalangeal fractures, alignment is key in fracture management is to prevent rotational malalignment tips. There are sixteen cases to date reported in the literature. Surgical treatment of intraarticular fractures of the trapezium. The trapezium also known as the greater multangular is one of the eight carpal bones of the hand. Isolated fractures of the trapezium are only thought to account for 35% of all carpal fractures 12. Postoperative management of carpometacarpal joint fracture dislocation of the hand.
Trapezium fractures are very rare and can lead to significant deficit of hand function if missed. It will be difficult to perform many weight bearing activities. 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. In addition, either the dorsal or volar radiotriquetral ligaments may avulse triquetral fragments at their. In treating a fracture, the objectives of the treatment are as follows. If the scaphoid fracture is not healing, you may or may not continue to have symptoms. Vertical sagittal split fractures of the body of trapezium occur rarely in isolation and accounts for 20% of these fractures. The authors report and discuss the management of a 25yearold male patient with a trapeziometacarpal joint dislocation complicated by a trapezium fracture. If the doctor is concerned that it wont heal without surgery or that it would heal and result in pain andor dysfunction, the doctor will discuss surgery. It is likely that an isolated trapezoid fracture will be missed on plain films, especially. Bennetts fracture associated with fracture of trapezium. Traumatic isolated trapezium dislocation without fracture. We report a case of a young adult male who presented with such an injury after a motor vehicle accident. Using a tightrope to treat a complex fracture of the trapezium.
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