Isolated palmar dislocation of the trapezoid associated with distal radius fracture in a patient with major trauma: A case report and literature review

Abstract

Trapezoid dislocation is infrequent, and palmar trapezoid dislocation is even more rare. This uncommon injury is associated with high-energy trauma and is often combined with other distracting injuries that may lead to misdiagnosis or delayed diagnosis. We present a case of isolated palmar dislocation of the trapezoid in a 49-year-old man with major trauma following a motor vehicle accident. We identified the dislocation by radiograph and performed open reduction and internal fixation (ORIF) after primary management of his major trauma. The patient recovered with satisfactory hand and wrist function. We share our experience and review the pitfalls in diagnosis and treatment for this rare injury.

Keywords: Carpometacarpal; Cascade lines; Dislocation; Trapezoid.

Fig. 1

(A) Anterior-posterior view of the wrist. The white arrows indicate the metacarpal cascade lines and the red arrow indicates the abnormality of the second metacarpal. The orange dotted line shows the curve of the metacarpal head. The shortening of the second metacarpal was not obvious. (B) Oblique view of the wrist after external skeletal fixation. (C) Computed tomography (CT) scan of the wrist confirming palmar dislocation. (D) Proximal dislocation of the index metacarpal base to the space left by the trapezoid dislocation. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)

Fig. 2

(A) Oblique view of the wrist 2 days postoperation (B) Anterior-posterior view of the wrist 5 months postoperation with good alignment of the distal radius and carpal bones. (C) Flexion and (D) extension of the finger 5 months postoperation.