Combined dislocation of the trapezium and the trapezoid: a case report with review of the literature

Abstract

Dislocation of the either the trapezium or the trapezoid are both rare injuries, even among carpal dislocations. We report a case of combined volar trapezium dislocation and dorsal trapezoid dislocation with other concomitant injuries. A review of the literature regarding trapezium and trapezoid dislocations as well as the treatment of these injuries is presented.

Figure 1

Attempted anteroposterior forearm radiograph demonstrating distal radius shaft fracture as well as carpal and carpometacarpal injuries.

Figure 2

Oblique wrist radiograph in traction demonstrating dislocations of the trapezium at the scaphotrapezial and carpometacarpal articulations, the trapezoid at the scaphotrapezoidal and carpometacarpal articulations, and the capitate at the carpometacarpal articulation. Additionally, there is a fracture of the base of the thumb metacarpal as well as a fracture of the distal radius shaft.

Figure 3

a Three-dimensional reconstruction CT scan after initial attempted reduction demonstrating volar dislocation of the trapezium, dorsal dislocation of the trapezoid, and fracture of the base of the thumb metacarpal. b Three-dimensional reconstruction CT scan after initial attempted reduction demonstrating volar dislocation of the trapezium, fracture of the base of the thumb metacarpal, and disruption of the capitometacarpal articulation. c Three-dimensional reconstruction CT scan after initial attempted reduction demonstrating disruption of the capitometacarpal articulation as well as the trapeziometacaarpal articulation.

Figure 4

a Posteroanterior wrist radiograph 6 weeks after initial operative stabilization. b Lateral wrist radiograph 6 weeks after initial operative stabilization.

Figure 5

a Coronal CT scan 7 months after initial operative stabilization demonstrating reduction of the thumb CMC joint. b Coronal CT scan 7 months after initial operative stabilization demonstrating reduction of the index CMC joint. c Anteroposterior wrist radiograph 20 months after initial operative stabilization demonstrating arthrosis of the scaphotrapeziotrapezoidal joint as well as of the thumb carpometacarpal joint. d Lateral wrist radiograph 20 months after initial operative stabilization demonstrating arthrosis of the scaphotrapeziotrapezoidal joint.