Arabzadeh A, Vosoughi F. Isolated comminuted trapezium fracture: A case report and literature review.
Int J Surg Case Rep 2020;
78:363-368. [PMID:
33401191 PMCID:
PMC7787926 DOI:
10.1016/j.ijscr.2020.12.072]
[Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 12/21/2020] [Accepted: 12/21/2020] [Indexed: 11/18/2022] Open
Abstract
Isolated Trapezium fracture is difficult to be detected causing 1st carpometacarpal joint degeneration and limitation of thumb motion.
In order not to miss trapezium fracture, a high index of suspicion is required.
Persistent pain in the anatomical snuffbox or thenar eminence following a trauma should alert the physician to consider trapezium fracture.
Open reduction and internal fixation even without graft seem to be a plausible choice for managing comminuted trapezium fracture.
Introduction and importance
Trapezium, as a carpal bone positioned at the distal row, is often associated with other wrist injuries such as distal radius fracture. Isolated trapezium fracture, especially in a comminuted form, rarely occurs. There are only six reports of isolated comminuted trapezium fractures in the literature to the best of our knowledge.
Case presentation
We present a case with an isolated comminuted trapezium fracture presenting pain in his thenar eminence and thumb motion limitation. He was treated by Open Reduction and Internal Fixation (ORIF) with the K wire pin.
Clinical discussion
We searched the published related studies and summarized the signs and symptoms of patients presented with trapezium fracture. The most common presentation of trapezial fracture include pain/tenderness at the base of the first metacarpal bone, pain/tenderness at the snuffbox area and 1st digit motion limitation. The treatment options described in the literature for isolated comminuted trapezium fracture are also presented. Open reduction and fixation with pin is the most common treatment mentioned in the literature. The priority is restoring the scaphotrapezial and trapeziometacarpal joint congruency to save the 1st digit range of motion.
Conclusion
Comminuted trapezial fracture may happen following either low energy (like our patient) or high energy trauma. This paper highlights the fact that even a comminuted trapezium fracture can be easily missed. Regardless of the trauma mechanism (high energy versus low energy trauma), a high index of suspicion and delicate work up would be necessary in order not to miss this type of fracture.
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