Management of combined open fractures of thumb metacarpal and trapezium (surgical tip)

Abstract

Management of an unusual injury of combined open fractures of the first metacarpal shaft and trapezium due to crush injury in a 21-year-old man was reported in this paper. 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. After 1 year of surgery, follow-up functional and radiographic evaluations were satisfactory, and most of the daily activities were pain-free.

Figure 1

Radiograph showing thumb metacarpal shaft and trapezium factures. Note both fractures are comminuted with some degree of collapse of trapezium and marked displacement of the thumb metacarpal shaft fracture.

Figure 2

Radiograph showing fracture reduction of the thumb metacarpal shaft followed by stabilization of both bone fractures with a dorsally applied external fixator, with slight distraction (postoperative first day).

Figure 3

Photographs of the original open wound a after the fractured thumb metacarpal was reduced, b after the external fixator was applied and wound closure completed.

Figure 4

Radiograph at the last follow-up visit (postoperative 1 year) showed the evidence of union in good alignment and no sign of arthritic changes at the first carpometacarpal joint.