Operative Treatment of an Isolated, Comminuted, Biarticular Trapezium Fracture: A Case Report and Review of the Literature

Abstract

Background Isolated, highly comminuted trapezium fractures are extremely rare. While they can be initially diagnosed with plain radiographs, a computed tomography scan of the wrist will more clearly reveal the fracture details and aid in appropriate preoperative planning. Restoration of the fracture with a congruent reduction of the adjacent joints is mandatory for a favorable prognosis.

Case Description A case of a highly comminuted, biarticular, trapezium fracture in a young male patient that was treated operatively with open reduction and internal fixation (ORIF) with a cannulated miniscrew and an additional Kirschner wire (K-wire) is presented. Restoration of a decent intra-articular congruity of the trapezium with both the base of the first metacarpal distally and the scaphoid bone proximally ensured a favorable outcome.

Literature Review Various operative techniques are presented in current literature, encompassing ORIF with screws and K-wires, closed reduction and percutaneous fixation with K-wires, mini-external fixation, button fixation, and arthroscopically assisted percutaneous fixation. A favorable prognosis is documented in cases where a congruous reduction of the fracture was achieved and maintained throughout the healing period.

Clinical Relevance We feel that a formal ORIF is the procedure of choice for highly comminuted trapezium fractures, as they are not easily amenable to accurate reduction by means of closed methods.

Keywords

trapezium - comminuted - fracture - operative treatment

Ethical Approval

The present research was approved by the Institutional Review Board.

Publikationsverlauf

Eingereicht: 18. April 2024

Angenommen: 25. Juni 2024

Artikel online veröffentlicht:
18. Juli 2024

• References

• 1 Catalano III LW, Minhas SV, Kirby DJ. Evaluation and management of carpal fractures other than the scaphoid. J Am Acad Orthop Surg 2020; 28 (15) e651-e661
• 2 Beekhuizen SR, Quispel CR, Jasper J, Deijkers RLM. The uncommon trapezium fracture: a case series. J Wrist Surg 2020; 9 (01) 63-70
• 3 McGuigan FX, Culp RW. Surgical treatment of intra-articular fractures of the trapezium. J Hand Surg Am 2002; 27 (04) 697-703
• 4 Ramoutar DN, Katevu C, Titchener AG, Patel A. Trapezium fracture - a common technique to fix a rare injury: a case report. Cases J 2009; 2: 8304
• 5 Palmer AK. Trapezial ridge fractures. J Hand Surg Am 1981; 6 (06) 561-564
• 6 Suresh S. Isolated coronal split fracture of the trapezium. Indian J Orthop 2012; 46 (01) 99-101
• 7 Alonso L, Couceiro J. Comminuted fracture of the body of the trapezium and thumb carpometacarpal dislocation: a particular pattern. Surg J (NY) 2018; 4 (01) e34-e36
• 8 Martins IL, Vasques AL, Pereira FG, Brito F, Sousa R. Open reduction and fixation of trapezium fracture. Case Report. MOJ Orthop Rheumatol. 2017; 9 (03) 00356
• 9 Gvozdenovic R, Soelberg Vadstrup L. Total carpometacarpal joint dislocation combined with trapezium fracture, trapezoid dislocation and hamate fracture. Chir Main 2015; 34 (05) 264-268
• 10 Agha RA, Franchi T, Sohrabi C, Mathew G, Kerwan A. SCARE Group. The SCARE 2020 guideline: updating consensus Surgical Case Report (SCARE) guidelines. Int J Surg 2020; 84: 226-230
• 11 Walker JL, Greene TL, Lunseth PA. Fractures of the body of the trapezium. J Orthop Trauma 1988; 2 (01) 22-28
• 12 Arabzadeh A, Vosoughi F. Isolated comminuted trapezium fracture: a case report and literature review. Int J Surg Case Rep 2021; 78: 363-368
• 13 Kob A, Lang A, Thelen R, Schild H. Radiologic diagnosis of injuries of the wrist [in German]. Rontgenblatter 1988; 41 (05) 215-220
• 14 Gibney B, Murphy MC, Ahern DP, Hynes D, MacMahon PJ. Trapezium fracture: a common clinical mimic of scaphoid fracture. Emerg Radiol 2019; 26 (05) 531-540
• 15 Spielman AF, Sankaranarayanan S. Comminuted trapezium fracture: case presentation and review of surgical fixation techniques. Case Rep Orthop 2021; 2021: 5532713
• 16 Kose O, Keskinbora M, Guler F. Carpometacarpal dislocation of the thumb associated with fracture of the trapezium. J Orthop Traumatol 2015; 16 (02) 161-165
• 17 Eda Y, Totoki Y, Nakagawa T, Yamazaki M. A case report of comminuted trapezium fracture with surgical treatment. Trauma Case Rep 2022; 42: 100732
• 18 Pina G, Vaz MR, Vaz A, Abrantes A, Rodrigues LM. Trapezium and Bennett fracture - a rare base thumb fracture pattern: a case report. J Orthop Case Rep 2021; 11 (05) 99-103
• 19 Mohammed S, Mouncef A, Walid B, Amin H, Mohammed B, Abdelkrim D. Surgical treatment for the uncommon bi-articular fracture of trapezium: a case report. Clin Case Rep 2023; 11 (06) e7118
• 20 Pehlivan O, Cilli F, Mahirogullari M, Ozyurek S. Management of combined open fractures of thumb metacarpal and trapezium (surgical tip). Hand (N Y) 2007; 2 (02) 48-50
• 21 Shenouda ME, Mohan A, Sarkhel T. Using a TightRope® to treat a complex fracture of the trapezium. Ann R Coll Surg Engl 2014; 96 (07) e36-e38
• 22 Wiesler ER, Chloros GD, Kuzma GR. Arthroscopy in the treatment of fracture of the trapezium. Arthroscopy 2007; 23 (11) 1248.e1-1248.e4
• 23 Tandioy-Delgado FA, Marcovici LL, Luchetti R, Atzei A. Arthroscopic assisted treatment of combined trapezium and Bennett fracture-dislocation. Tech Hand Up Extrem Surg 2023; 27 (01) 30-37
• 24 Suthersan M, Chan S. Isolated comminuted fracture of the trapezium: a case report and review of the literature. The Internet J Orthopedic Surg 2010; 18 (02) x
• 25 Roger J, Mathieu L, Mottier F, Vigouroux F, Chauvin F, Rongiéras F. Trapeziometacarpal joint dislocation complicated by a trapezium fracture: a case report and literature review. Hand Surg Rehabil 2016; 35 (04) 288-291
• 26 Kohyama S, Tanaka T, Ikumi A, Totoki Y, Okuno K, Ochiai N. Trapezium fracture associated with thumb carpometacarpal joint dislocation: a report of three cases and literature review. Case Rep Orthop 2018; 2018: 2408708
• 27 Roy A, Dutta S, Kar GG. Late isolated comminuted trapezium fracture with carpometacarpal subluxation: a case report. Int J Orthopaedic Surgery 2022; 30 (02) 67-69