The Uncommon Trapezium Fracture: A Case Series

Abstract

Background Isolated trapezium fractures are rare and account for only 1 to 5% of all carpal fractures but are still the third most common carpal fracture. Trapezium fractures are hard to detect and easily missed on standard radiographs. Trapezium fractures can be treated conservatively, as well as operatively, the best treatment is still debatable. Damage of the joint surface between the trapezium and the base of the first metacarpal or scaphoid could cause pain and restriction of movements. Therefore, it is important to diagnose and treat the fracture at early stage, so that articular congruence is guaranteed. Case description We present four cases of the uncommon trapezium fracture. All four cases are conservatively treated with good results, there was no need for operative treatment in all the cases. Literature review The literature describes the possibility to use fixation techniques, only when it is not possible to reduce the displaced fracture or the residual articular step-off is too high a fixation technique should be used. Clinical relevance Primarily, we would recommend navicular cast immobilization for 4 to 6 weeks as initial treatment.

Keywords: casting; conservative treatment; fracture; trapezium; uncommon.

Fig. 1

Walker's classification; type I: horizontal sagittal split, type IIa: medial distal avulsion, type IIb: medial proximal avulsion, type III: lateral distal avulsion, type IV: vertical sagittal split, and type V: communitive.

Fig. 2

Case 1; ( A ) X-ray AP view, ( B ) X-ray lateral view, ( C ) CT-scan lateral view, ( D ): CT scan AP view, ( E ): CT-scan transversal view. AP, anteroposterior; CT, computed tomography.

Fig. 3

Case 2; ( A ) X-ray AP view, ( B ) X-ray lateral view, ( C ) CT-scan AP view, ( D ) CT-scan lateral view, ( E ) CT-scan transversal view. AP, anteroposterior; CT, computed tomography.

Fig. 4

Case 3; ( A ) X-ray AP view, ( B ) X-ray lateral view, ( C ) CT-scan AP view, ( D ) CT-scan lateral view, ( E ) CT-scan: 3D reconstruction. 3D, three-dimensional; AP, anteroposterior; CT, computed tomography.

Fig. 5

Case 4; ( A ) X-ray AP view, ( B ) X-ray lateral view, ( C ) CT-scan AP view, ( D ): CT-scan lateral view, ( E ): CT-scan transversal view. AP, anteroposterior; CT, computed tomography.

Fig. 6

Anatomy of the Trapezium. C, capitatum; FCR, flexor carpi radialis groove; L, lunatum; MC1, first metacarpal; MC2. second metacarpal; MC3, third metacarpal; R, radius; S, scaphoid; Td, trapezoid; Tm, trapezium.