Isolated comminuted trapezium fracture: A case report and literature review

Abstract

Introduction and importance: Trapezium, as a carpal bone positioned at the distal row, is often associated with other wrist injuries such as distal radius fracture. Isolated trapezium fracture, especially in a comminuted form, rarely occurs. There are only six reports of isolated comminuted trapezium fractures in the literature to the best of our knowledge.

Case presentation: We present a case with an isolated comminuted trapezium fracture presenting pain in his thenar eminence and thumb motion limitation. He was treated by Open Reduction and Internal Fixation (ORIF) with the K wire pin.

Clinical discussion: We searched the published related studies and summarized the signs and symptoms of patients presented with trapezium fracture. The most common presentation of trapezial fracture include pain/tenderness at the base of the first metacarpal bone, pain/tenderness at the snuffbox area and 1st digit motion limitation. The treatment options described in the literature for isolated comminuted trapezium fracture are also presented. Open reduction and fixation with pin is the most common treatment mentioned in the literature. The priority is restoring the scaphotrapezial and trapeziometacarpal joint congruency to save the 1st digit range of motion.

Conclusion: Comminuted trapezial fracture may happen following either low energy (like our patient) or high energy trauma. This paper highlights the fact that even a comminuted trapezium fracture can be easily missed. Regardless of the trauma mechanism (high energy versus low energy trauma), a high index of suspicion and delicate work up would be necessary in order not to miss this type of fracture.

Keywords: Carpometacarpal joints; Case report; Range of motion; Trapezium bone.

Fig. 1

Preoperative radiograph and CT scan images show the comminution of trapezium fracture.

Fig. 2

Postoperative radiographs show a suitable reduction of the 1st carpometacarpal articular surface. Black arrows display the fracture line.

Fig. 3

Postoperative radiographs after sixty-six months. Note the excellent congruency of the carpometacarpal joint without considerable degenerative changes.

Fig. 4

Stabilizing Ligaments of the trapeziometacarpal joint. a: Anterior view, b: Posterior view. Abbreviations: IML, intermetacarpal ligament; UCL, ulnar collateral ligament; AOL, anterior oblique ligament; TCL, transverse carpal ligament; POL, posterior oblique ligament; DRL, dorsoradial ligament; APL, abductor pollicis longus.

Fig. 5

Walker classification for Trapezium fracture. a: Horizontal fracture (type Ⅰ), b: Radial tuberosity fracture through the CMC joint (type Ⅱa), c: Radial tuberosity fracture through the Scaphotrapezial joint (type Ⅱb), d: Ulnar tuberosity fracture (type Ⅲ), e: Vertical fracture (type Ⅳ), d: Comminuted fracture (type Ⅴ).