Occult isolated fracture of the trapezoid diagnosed by ultrasonography

Minimally Invasive Surgery for Trapezoid Nonunion: Case Report and Review of the Literature

We report a case of trapezoid nonunion diagnosed 3 months post injury. A 25-year-old male patient felt continuous wrist pain after being injured. His radiograph showed non-union with sclerotic change and bone resorption. He was planned for surgery, and this was done using a minimally invasive technique. Via a dorsal approach, we percutaneously drilled to the nonunion site and freshened the fracture ends. Bone plugs were harvested from the iliac crest using a bone marrow biopsy needle and packed into the nonunion site. The fracture was then fixed with a cannulated headless compression screw. This procedure could be performed without injuring the ligaments around the trapezoid. The patient was immobilised for 4 weeks, and bone union was achieved 6 months after surgery. He had full range of finger and wrist motion and no pain at the final follow-up. Level of Evidence: Level V (Therapeutic).

Isolated trapezoid fracture: four cases of a rare fracture on MRI

Isolated trapezoid fractures have been rarely reported in the literature and are occult on routine radiography. Previously described cases have utilized computed tomography (CT) to make this diagnosis; however, magnetic resonance imaging (MRI) is better for soft tissue evaluation and can detect fractures which may be occult on CT. We report 4 cases of isolated trapezoid fractures diagnosed by MRI in 4 males after remote trauma, ages ranging from 19 to 62. In each case, initial work-up with radiography, and one case with CT, was negative for a fracture but an MRI was ultimately obtained due to high clinical suspicion, resulting in the diagnosis of an isolated trapezoid fracture. Based on literature review, these are the first cases of isolated trapezoid fracture diagnosed by MRI. MRI offers several advantages over CT and is more valuable in cases of suspected occult fracture, given the ability to evaluate soft tissue and ligamentous injuries.

Isolated Trapezoid Fracture in a Boxer

Patient: Male, 33

Final Diagnosis: Trapezoid fracture

Symptoms: Pain during active flexion/extension of the wrist tenderness at the base of the second metacarpal

Medication: —

Clinical Procedure: Cast immobilisation

Specialty: Orthopedics and Traumatology