Open Reduction and Fixation of Trapezium Fracture

Abstract

Trapezium fractures are very rare and can lead to significant deficit of hand function if missed. The purpose of this article is to document and discuss the surgical treatment performed to a 34-year-old man who sustained a closed isolated vertical split fracture of the trapezium on his left non-dominant hand. The patient was treated at our Orthopaedic Surgery Department. We performed an open reduction (by a dorsal approach) and internal fixation with a headless compression screw. At the last follow-up 6 months post-op, the functional outcome was excellent. The patient had no complains, complete wrist and thumb range of motion and hand grip and pinch strength comparable to the contralateral limb. The Disabilities of the Arm, Shoulder and Hand (DASH) score was 7.5. The technique applied ensured a stable and anatomic restoration of the articular joint surface. We decided to discard post-surgical plaster immobilization, which enabled earlier rehabilitation. Furthermore, we believe that the re-establishment of the articular surface will minimize the long-term degenerative changes at the trapeziometacarpal (TMC) joint.

Rare Isolated Trapezium Fracture: Clinical Case Presentation

“…Associated fractures are reported in 80% of cases 1 such as Bennett's fracture, Rolando's fracture, fractures of the scaphoid 4,5 and distal radius fractures. 3 Occasionally they may also be associated with ligament damage. 6 The presented case had no associated injuries.…”

“…Among different carpal bones, those placed at the proximal row are more prone to fracture. 1 Trapezium fractures are rare, accounting for 0.4% of hand's injuries 2,3 and 3%-5% of carpal fractures. [4][5][6] Due to the low prevalence and difficulty in diagnosing isolated trapezium fractures by routine imaging, high clinical suspicion, careful history taking, physical examination, and imaging interpretation are needed to avoid missing this diagnosis.…”

“…7 Several treatment options have been described in the literature. 3,6,7 In this paper, we report a case of a 54-year-old male patient with an isolated trapezium fracture following a motorcycle accident. It then further delineates its clinical and radiologic outcomes.…”

Trapezium and Bennett Fracture – A Rare Base Thumb Fracture Pattern:A Case Report

“…Reports of surgical treatment range from closed reduction and percutaneous fixation with Kirschner wires and open reduction and internal fixation with screws or Kirschner wires. These different types of treatment are all associated with excellent results throughout the literature [ 1 , 2 , 3 , 4 , 15 , 16 , 17 , 18 , 19 , 20 , 21 ]. Also described in the treatment of comminuted fractures, is the use of external fixation and button fixation, whose biomechanical objective is to maintain trapezius height while healing.…”

Trapezium Fracture: Case Report

“…Isolated fractures of the trapezium account for 3-5% of all carpal fractures (1,2) . However, they should not be missed because inadequate treatment of trapezium fractures can lead to permanent impairment based on the substantial forces experienced at the trapeziometacarpal (TMC) joint in pinch and grip (3,4) .…”