Dorsal Dislocation of the Trapezoid with CARPO-METACARPAL Dislocations: A Case Report and a Description of the “Missing Carpal Sign” on Radiographs

Wright, Andrew; Umaar, Rowena

doi:10.1016/j.jemermed.2014.06.021

Cited by 5 publications

(11 citation statements)

References 6 publications

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“…Trapezoidal dislocations are extremely rare injuries that have been reported as isolated cases or small case series. [1][2][3][4][5][6][7][8][9][10][11]14 Axial loading of the second metacarpal with the wrist flexed has been postulated to result in dorsal trapezoidal dislocation because of weaker ligamentous attachments dorsally and the wedge shape of the trapezoid at the STT articulation, where the trapezoid becomes exposed and loses its bony support from the scaphoid with the wrist in flexion. 4,11,15 Traditional mechanisms of injury included industrial accidents, Fig.…”

Section: Discussionmentioning

confidence: 99%

“…The most commonly described associated injuries include trapezium dislocation as part of an axial radial disruption of the carpus 1,2,4 and multiple CMC dislocations. 1,3,[6][7][8][9][10][11] Complete dislocation of the trapezoid from the scaphoid and second metacarpal articulations with proximal migration of the second metacarpal into the remaining defect has also been described. 1,4,16,17 Palmar dislocations of the trapezoid appear to be less common than dorsal dislocations because the palmar ligamentous attachments of the trapezoid are stronger than the dorsal ligaments.…”

Section: Discussionmentioning

confidence: 99%

“…Dislocation of the trapezoid at the scaphotrapeziotrapezoidal (STT) joint is a rare injury typically resulting from high-energy trauma. [1][2][3][4][5][6][7][8][9][10] Previously reported mechanisms of injury include industrial trauma, motorcycle accidents, and falls from height. [1][2][3][4][5][6][7][8] Recently, an axial loading mechanism from the steering wheel during a head-on collision has been described to result in these injuries.…”

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confidence: 99%

“…6,7 Concomitant injuries to the hand, including multiple carpometacarpal (CMC) joint fractures/dislocations and associated carpal bone fractures, are commonly associated with trapezoidal dislocations, and isolated injury has been extremely rare in the literature. 1,3,[6][7][8][9][10][11] These injuries are easier to recognize on plain radiographs and may distract attention away from the more subtle findings of trapezoidal injury at the STT joint.…”

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confidence: 99%

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Dorsal Dislocation of the Trapezoid at the Scaphotrapeziotrapezoidal Joint

2015

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Background Axial dislocations of the trapezoid are rare, high-energy injuries. We present an unusual case of isolated dorsal dislocation of the trapezoid and index metacarpal at the scaphotrapeziotrapezoidal (STT) joint due to steering wheel injury. Case Description A 56-year-old man presented to our office with right hand pain for 10 days after a head-on motor vehicle accident (MVA) in which he suffered an axial load injury to his hand on the steering wheel. X-ray images were reported as unremarkable. Further workup with computed tomography (CT) scan revealed an isolated dorsal dislocation of the trapezoid with its associated index metacarpal at the STT joint. The patient was treated with open reduction, pinning, and dorsal capsulodesis. Literature Review Dorsal dislocation of the trapezoid has been associated with high-energy trauma such as industrial accidents or motorcycle accidents; however, recent case reports have also revealed an axial loading mechanism from a steering wheel injury as an increasingly common mechanism. These cases typically occur concomitantly with other fractures or dislocations of the carpal bones or carpometacarpal (CMC) joints. Multiple reports of delayed diagnoses due to distracting injuries and difficulty of recognition on plain radiographs have been reported. Clinical Relevance Dorsal dislocation of the trapezoid with its associated second metacarpal is a rare, high-energy injury that can often be missed on plain radiography. We report a rare variant with no concomitant injury to the metacarpals or carpal bones. A low index of suspicion for further imaging should exist in the setting of an axial loading injury to the hand.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Dorsal Dislocation of the Trapezoid at the Scaphotrapeziotrapezoidal Joint

2015

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“…Die Diagnosestellung dieser seltenen karpalen Verletzungen stellt eine große Herausforderung für die erstbehandelnden Ärzte dar. In den wenigen Fallberichten wurden diese regelhaft übersehen, so dass stets eine verspätete Behandlung resultierte [16]. Eine frühzeitige operative Intervention ist jedoch ein wichtiger prognostischer Faktor für das postoperative funktionelle Ergebnis [13].…”

Section: Introductionunclassified

Transtrapezoidale Luxation: Ein Fallbericht

Latz¹,

Gehrmann²,

Jungbluth³

et al. 2017

Handchir Mikrochir plast Chir

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Fracture dislocations of the STT joint are extremely rare. We present the case of a 50-year-old worker, who sustained a crush injury of his left hand with a dorsal fracture dislocation of the trapezoid bone and the associated second metacarpal bone at the STT, and a concomitant compartment syndrome of the hand. The fracture was reduced immediately and compartment release was performed, followed by percutaneous stabilisation using three K-wires. Material removal after six weeks was followed by intensive physical therapy. At the final follow-up examination after three months, we observed a good recovery of hand function compared to the unaffected right side with 75 % grip strength, 90 % ROM in extension/flexion and full thumb opposition (Kapandji score 9/10). Immediate surgical treatment of this rare injury can lead to a good functional result of the hand.

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

Chang

Kuan

et al. 2021

Trauma Case Reports

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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.

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Dorsal Dislocation of the Trapezoid with CARPO-METACARPAL Dislocations: A Case Report and a Description of the “Missing Carpal Sign” on Radiographs

Cited by 5 publications

References 6 publications

Dorsal Dislocation of the Trapezoid at the Scaphotrapeziotrapezoidal Joint

Dorsal Dislocation of the Trapezoid at the Scaphotrapeziotrapezoidal Joint

Transtrapezoidale Luxation: Ein Fallbericht

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

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