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Trapezium Fracture
From WikiSM
Other Names
- Trapezium Fracture dislocation
Background
- The Trapezium is the 3rd most fractured carpal bone [1]
- Fracture-dislocations can also occur involving Scaphoid, Trapezoid, Capitate, Metacarpals and distal Radius
Pathophysiology
- Vertical intra-articular are most common fracture pattern
- Mechanism is typically axial compression from thumb thumb metacarpal
- Associated injuries:
Risk Factors
- Unknown
Differential Diagnosis
Carpal Bone Fractures
- Scaphoid Fracture
- Lunate Fracture
- Triquetrum Fracture
- Pisiform Fracture
- Trapezium Fracture
- Trapezoid Fracture
- Capitate Fracture
- Hamate Fracture
Differential Diagnosis Wrist Pain
- Fractures
- Dislocations
- Wrist Dislocation (Radiocarpal and/or Ulnocarpal)
- Carpometacarpal Joint Dislocation
- Distal Radioulnar Joint Dislocation
- Lunate Dislocation
- Perilunate Dislocation
- Instability & Degenerative
- Tendinopathies & Ligaments
- Neuropathies
- Pediatric Considerations
- Distal Radial Epiphysitis (Gymnast's Wrist)
- Torus Fracture
- Arthropathies
- Cartilage
- Vascular
- Other
Clinical Features
- General: Physical Exam Wrist
- Tenderness, ecchymosis over trapezium at the base of the Thenar Muscles
Evaluation
Radiographs
- Standard Radiographs Wrist
- Standard 3 view
- Consider: pronated anteroposterior, Bett view, carpal tunnel view
CT
- Better evaluate fracture pattern
Classification
- Vertical intra-articular[2]
- Horizontal
- Dorsal radial tuberosity
- Anterior medial ridge
- Comminuted
Management
Nonoperative
- Management generally driven by degree of displacement
- Indications
- Non-displaced
- Cast: Thumb Spica Cast for 4-6 weeks
Operative
- Indications
- Displaced fractures
- Fracture-dislocation
- Technique
- Percutaneous Kirschner wire fixation
- Oblique external traction
- Open reduction and internal fixation
Return to Play
- Dictated by physician
- On average 4-6 weeks
Complications
- Trapeziometacarpal arthritis
- Scaphotrapezium-trapezoid arthritis
- Nonunion
- Malunion
- Carpometacarpal Arthritis
- Carpal Tunnel Syndrome
- Flexor Carpi Radialis tendinopathy with late rupture
- Painful loss of pinch strength and function
See Also
- Internal
- External
- Sports Medicine Review Wrist Pain: https://www.sportsmedreview.com/by-joint/wrist/
References
- ↑ Pointu J, Schwenck JP, Destree G, Sejourne P. [Fractures of the trapezium: mechanisms, anatomo-pathology and therapeutic indications]. Rev Chir Orthop Reparatrice Appar Motil. 1988;74(5):454e465.
- ↑ Walker JL, Greene TL, Lunseth PA. Fractures of the body of the trapezium. J Orthop Trauma. 1988;2(1):22e28.
