Isolated coronal split fracture of the trapezium

Abstract

Trapezium fractures account for <5% of all carpal fractures. Of these about 20% are vertical sagittal fractures of the body of trapezium and are classified as type IV. We report a case of coronal fracture of the trapezium, which was treated by open reduction and internal fixation with Kirschner wires and ligamentotaxis by external fixator. This fracture pattern has not been reported before.

Keywords: Carpal bones; internal fixation; open reduction; trapezium carpometacarpal joint.

Figure 1

Anteroposterior radiograph of the wrist (a) showing the coronal fracture of the trapezium (b) after attempted reduction showing minimal subluxation of the CMC joint

Figure 2

CT scan (a) showing a major volar fragment (arrow head) and smaller dorsal fragment (white arrow) (b) 3D reconstruction CT scan showing the volar fragment (black arrow), dorsal fragment (black star), Scaphoid (S), and the first metacarpal (M)

Figure 3

(a) Postoperative radiograph showing the fixation with K-wires and a mini fixator (b) radiographs at 1-year follow-up showing healed fracture with congruent joints

Figure 4

Line drawing showing the (a) Walker type IV fracture and (b) the fracture pattern in this case report