RESUMEN
CASES: Two competitive athletes with isolated comminuted trapezium fractures, sustained during American football and rugby, presented with pain and swelling of the first metacarpal base. Computed tomography confirmed isolated comminuted trapezium fractures. Arthroscopic reduction of displacement with screw fixation below the articular surface was performed through a small incision. Both patients returned to their preinjury sports levels within 2 months postoperatively. CONCLUSION: Arthroscopic treatment of isolated comminuted trapezium fractures achieved accurate reduction of articular surface displacement and preserved trapeziometacarpal joint stability with minimal soft-tissue invasion. This facilitated an early return to contact sports for the affected athletes.
Asunto(s)
Artroscopía , Fracturas Conminutas , Hueso Trapecio , Humanos , Masculino , Artroscopía/métodos , Traumatismos en Atletas/cirugía , Traumatismos en Atletas/diagnóstico por imagen , Fijación Interna de Fracturas/métodos , Fracturas Conminutas/cirugía , Fracturas Conminutas/diagnóstico por imagen , Hueso Trapecio/cirugía , Hueso Trapecio/diagnóstico por imagen , Hueso Trapecio/lesionesRESUMEN
There are only a few reports regarding snapping thumb caused by the pathology of the extensor tendon. We report a rare case of snapping thumb caused by a displaced non-union fragment from the trapezium in a 54-year-old man treated with the surgical resection. The intraoperative findings and the outcome are described.
Asunto(s)
Articulaciones Carpometacarpianas/fisiopatología , Fracturas no Consolidadas/fisiopatología , Pulgar/fisiopatología , Hueso Trapecio/lesiones , Articulaciones Carpometacarpianas/diagnóstico por imagen , Articulaciones Carpometacarpianas/patología , Fibrosis/diagnóstico por imagen , Fracturas por Avulsión/diagnóstico por imagen , Fracturas por Avulsión/fisiopatología , Fracturas no Consolidadas/diagnóstico por imagen , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Osificación Heterotópica/diagnóstico por imagen , Osificación Heterotópica/fisiopatología , Radiografía , Hueso Trapecio/diagnóstico por imagenRESUMEN
PURPOSE: Fractures of the trapezium are rarely diagnosed on plain radiographs after acute wrist trauma. High-resolution cross-sectional imaging identifies fractures of the trapezium as the most common radiographically occult carpal bone fracture. We review the fracture frequency, mechanisms and patterns of trapezium fractures. METHODS: Cone beam CT was performed in patients with suspected radiographically occult radiocarpal fracture following acute injury. The frequency of carpal bone fractures was assessed and compared. RESULTS: Ninety-three radiographically occult wrist fractures were identified in 166 patients with acute trauma and negative radiographs. The trapezium was the most frequently fractured carpal bone, making up 20.4% of wrist fractures. Seventy-nine percent of trapezium fractures involved the volar ridge. The scaphoid was the clinically suspected fractured bone at initial assessment in 84% of patients with trapezium fractures. CONCLUSION: Fractures of the trapezium in acute wrist trauma are much more common than described in the literature. If initial radiographs are negative, a fracture of the trapezium is more likely to be present than one of the scaphoid, despite high levels of clinical suspicion for scaphoid injuries. Awareness of the types and mechanisms of trapezium fracture is important. Cross-sectional imaging should be considered in all cases of post-traumatic wrist pain with negative radiographs.
Asunto(s)
Tomografía Computarizada de Haz Cónico , Fracturas Óseas/diagnóstico por imagen , Hueso Escafoides/diagnóstico por imagen , Hueso Escafoides/lesiones , Hueso Trapecio/diagnóstico por imagen , Hueso Trapecio/lesiones , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Trapezium fracture is a rare clinical situation that several authors have described through clinical case reports. Nevertheless, there is currently no consensus on the best treatment. We report a case of trapezium nonunion, a situation which, to our knowledge, has never been described before.
Asunto(s)
Tornillos Óseos , Fracturas Óseas/cirugía , Radio (Anatomía)/trasplante , Hueso Trapecio/lesiones , Hueso Trapecio/cirugía , Autoinjertos , Fijación Interna de Fracturas , Curación de Fractura , Fracturas Óseas/diagnóstico por imagen , Humanos , Imagen por Resonancia Magnética , Masculino , Tomografía Computarizada por Rayos X , Hueso Trapecio/diagnóstico por imagen , Adulto JovenRESUMEN
BACKGROUND: Trapezium dislocations are rare injuries. METHODS: A PubMed search of the term "trapezium dislocation" was conducted. Publications reporting a complete trapezium dislocation were included in the review. RESULTS: The PubMed search resulted in 168 results. Fourteen publications reporting on 16 complete trapezium dislocations met inclusion criteria. A case of delayed diagnosis of a trapezium dislocation is presented. The literature is reviewed for pertinent clinically relevant information with respect to trapezium dislocations. A systematic method for radiographic analysis of trapezium dislocations and classification are described, and a treatment algorithm is presented. CONCLUSIONS: Trapezium dislocations are infrequent injuries with few cases reported in the literature. Given the rarity of this injury, diagnosis and appropriate treatment may be delayed due to difficulty in recognition. Using the described method of radiographic analysis, delayed diagnosis may be avoided with implementation of timely treatment.
Asunto(s)
Hilos Ortopédicos/efectos adversos , Luxaciones Articulares/diagnóstico por imagen , Dolor/etiología , Hueso Trapecio/lesiones , Hueso Trapecio/cirugía , Algoritmos , Diagnóstico Tardío , Humanos , Luxaciones Articulares/clasificación , Luxaciones Articulares/cirugía , Perdida de Seguimiento , Masculino , Huesos del Metacarpo/diagnóstico por imagen , Huesos del Metacarpo/patología , Articulación Metacarpofalángica/cirugía , Persona de Mediana Edad , Dolor/diagnóstico , Radiografía/métodos , Rango del Movimiento Articular/fisiología , Pulgar/fisiopatologíaRESUMEN
Incorrect or delayed diagnosis and treatment of the carpometacarpal fracture-dislocations is often associated with poor prognosis. We present a rare case of unusual pattern of injury, involving dorsal dislocation of four ulnar carpometacarpal joints, associated with fracture of the trapezium, a burst fracture of the trapezoid bone and an extra-articular fracture of the third distal of the radius. The first surgical intervention was followed by unsatisfactory results, confirmed by the CT scans. A second surgery followed and an open reduction and pinning with K wires performed. Post-operative follow up lasting for nine months revealed a very good surgical outcome.
Asunto(s)
Articulaciones Carpometacarpianas/lesiones , Luxaciones Articulares/cirugía , Fracturas del Radio/cirugía , Hueso Trapecio/lesiones , Hueso Trapezoide/lesiones , Adulto , Articulaciones Carpometacarpianas/cirugía , Humanos , Masculino , Hueso Trapecio/cirugía , Hueso Trapezoide/cirugíaAsunto(s)
Imagenología Tridimensional , Hueso Escafoides/diagnóstico por imagen , Hueso Escafoides/lesiones , Tomografía Computarizada por Rayos X , Hueso Trapecio/diagnóstico por imagen , Hueso Trapecio/lesiones , Traumatismos de la Muñeca/diagnóstico por imagen , Traumatismos de la Muñeca/fisiopatología , Accidentes por Caídas , Artrodesis , Niño , Femenino , Fuerza de la Mano , Humanos , Rango del Movimiento Articular , Hueso Escafoides/cirugía , Hueso Trapecio/cirugía , Traumatismos de la Muñeca/cirugíaRESUMEN
Multiple metacarpal dislocations combined with carpal fracture - dislocations are rare injuries. We report a new combination of these injuries where fracture-dislocation of the base of the 1st metacarpal bone occurred simultaneously with a comminuted fracture of the trapezium, dislocation of the trapezoid and metacarpal joints (2nd to 5th) and an avulsion fracture of the hamate. This specific carpal injury has not been previously described and our description will contribute to understanding the mechanism of these complex injuries. The injury pattern in the case featured here was multifaceted and resulted from rupture of both transverse and longitudinal carpal columns. According to the Garcia-Elias classification of axial carpal disruptions, this particular injury mechanism was a combined axial-radial-ulnar type injury. These injuries are extremely rare and are only sporadically described in the literature. Trapeziectomy, followed by open, partial, low-profile screw fixation of the fracture of the first metacarpal and open reduction and pinning of the carpometacarpal joints and the trapezoid injury yielded a good result at the 1-year follow-up.
Asunto(s)
Articulaciones Carpometacarpianas/lesiones , Fracturas Óseas/complicaciones , Hueso Ganchoso/lesiones , Luxaciones Articulares/complicaciones , Traumatismo Múltiple , Hueso Trapecio/lesiones , Hueso Trapezoide/lesiones , Adulto , Articulaciones Carpometacarpianas/cirugía , Fracturas Óseas/cirugía , Hueso Ganchoso/cirugía , Humanos , Luxaciones Articulares/cirugía , Masculino , Traumatismo Múltiple/cirugía , Hueso Trapecio/cirugía , Hueso Trapezoide/cirugíaRESUMEN
Trapezium fractures comprise approximately 3% to 5% of all hand fractures. Although operative management of intra-articular trapezium fractures can result in good functional outcomes, there is very little literature addressing specific operative techniques. We describe a technique for open reduction and internal fixation of severely comminuted, intra-articular trapezium fractures, utilizing autogenous cancellous bone graft from the distal radius.
Asunto(s)
Trasplante Óseo/métodos , Fijación Interna de Fracturas/métodos , Fracturas Conminutas/cirugía , Radio (Anatomía)/trasplante , Hueso Trapecio/lesiones , Hueso Trapecio/cirugía , Adolescente , Autoinjertos , Hilos Ortopédicos , Moldes Quirúrgicos , Femenino , Fijación Interna de Fracturas/instrumentación , Humanos , Masculino , Complicaciones Posoperatorias , Rango del Movimiento Articular , Férulas (Fijadores) , Resultado del Tratamiento , Adulto JovenRESUMEN
Carpometacarpal dislocation (CMC) of the thumb associated with fracture of trapezium is an extremely rare injury, with only 12 cases that sustained similar injuries reported in the literature. In this article, another patient with this rare injury was reported, and all previously published cases were extensively reviewed. The presented case and all previously published cases had a longitudinally oriented trapezium fracture, which is naturally unstable and almost always associated with dislocation of the CMC joint. In contrast to previous descriptions, we believe that CMC joint dislocation and trapezium fracture are not two distinct pathologies that occur simultaneously by chance but share cause and consequence.
Asunto(s)
Huesos del Carpo/lesiones , Luxaciones Articulares/terapia , Pulgar/lesiones , Hueso Trapecio/lesiones , Accidentes de Tránsito , Adulto , Huesos del Carpo/diagnóstico por imagen , Humanos , Luxaciones Articulares/diagnóstico por imagen , Masculino , Radiografía , Rango del Movimiento Articular , Pulgar/diagnóstico por imagen , Hueso Trapecio/diagnóstico por imagenRESUMEN
We present the case of a 23-year-old man with a combined scaphoid fracture and comminuted trapezium fracture, treated surgically with percutaneous fixation of the scaphoid fracture and concomitant Arthrex Mini TightRope(®) stabilisation of base of thumb metacarpal to base of index finger metacarpal. The patient made a good functional recovery, returning to usual activities within six weeks. We suggest that this technique could be used to treat complex trapezium fractures that cannot be reconstructed with surgery.
Asunto(s)
Fijación Interna de Fracturas/instrumentación , Fijación Interna de Fracturas/métodos , Fracturas Conminutas/cirugía , Hueso Escafoides/lesiones , Hueso Trapecio/lesiones , Accidentes de Tránsito , Tornillos Óseos , Hilos Ortopédicos , Articulaciones Carpometacarpianas , Fracturas Óseas/diagnóstico por imagen , Fracturas Óseas/cirugía , Fracturas Conminutas/diagnóstico por imagen , Humanos , Masculino , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Motocicletas , Radiografía , Rango del Movimiento Articular/fisiología , Recuperación de la Función , Hueso Escafoides/diagnóstico por imagen , Hueso Escafoides/cirugía , Hueso Trapecio/diagnóstico por imagen , Hueso Trapecio/cirugía , Resultado del Tratamiento , Adulto JovenRESUMEN
Carpal fractures are exceedingly rare clinical entities and are often associated with concomitant injuries. In this review, we focus on fractures of the carpus, excluding the scaphoid, and provide an update on the current consensus as to mechanism, diagnosis, management, outcomes, and complications after such injuries.
Asunto(s)
Huesos del Carpo/lesiones , Fracturas Óseas/cirugía , Traumatismos de la Muñeca/cirugía , Hueso Grande del Carpo/lesiones , Hueso Grande del Carpo/cirugía , Huesos del Carpo/diagnóstico por imagen , Fracturas Óseas/diagnóstico por imagen , Hueso Ganchoso/lesiones , Hueso Ganchoso/cirugía , Humanos , Hueso Pisiforme/lesiones , Hueso Pisiforme/cirugía , Tomografía Computarizada por Rayos X , Hueso Trapecio/lesiones , Hueso Trapecio/cirugía , Hueso Piramidal/diagnóstico por imagen , Hueso Piramidal/lesionesRESUMEN
Trapezial ridge fractures are very rare. These can be a diagnostic challenge and one needs to have a high index of suspicion. We report two cases of trapezial ridge fractures that were diagnosed sonographically and confirmed by cross-sectional imaging (CT or MRI).
Asunto(s)
Fracturas Óseas/diagnóstico por imagen , Hueso Trapecio/diagnóstico por imagen , Hueso Trapecio/lesiones , Ultrasonografía Doppler en Color/métodos , Diagnóstico Diferencial , Fracturas Óseas/patología , Humanos , Imagenología Tridimensional/métodos , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos X/métodosAsunto(s)
Accidentes por Caídas , Artralgia/diagnóstico por imagen , Fracturas Óseas/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Hueso Trapecio/lesiones , Traumatismos de la Muñeca/diagnóstico por imagen , Adulto , Artralgia/cirugía , Diagnóstico Diferencial , Femenino , Fijación Interna de Fracturas , Fracturas Óseas/cirugía , Humanos , Fracturas del Radio/diagnóstico por imagen , Hueso Escafoides/diagnóstico por imagen , Hueso Trapecio/diagnóstico por imagen , Hueso Trapecio/cirugía , Traumatismos de la Muñeca/cirugíaRESUMEN
We report a case of traumatic axial disruption of the radial mid carpal joint. This unusual type of scaphotrapezo-trapezoïdal dislocation occurred after falling from a height. We performed open reduction and wire fixation. At 12months follow-up, functional outcome was satisfactory with good muscle strength (clamping force, grip strength and pinch grip: 90% compared to the opposite side) and good range of motion was preserved. Work was resumed at the tenth week. Radial midcarpal disruption is uncommon. It includes the separation of the trapezium, trapezoïdal, first and second and third metacarpal bones from the remaining wrist. This pattern of carpal derangement has not been previously described in the literature. Mechanism of the injury and treatment are discussed.
Asunto(s)
Huesos del Carpo/lesiones , Articulaciones del Carpo/lesiones , Luxaciones Articulares/etiología , Huesos del Metacarpo/lesiones , Accidentes por Caídas , Adulto , Huesos del Carpo/cirugía , Articulaciones del Carpo/cirugía , Estudios de Seguimiento , Fijación Interna de Fracturas/métodos , Fuerza de la Mano , Humanos , Luxaciones Articulares/patología , Luxaciones Articulares/cirugía , Masculino , Huesos del Metacarpo/cirugía , Radio (Anatomía)/lesiones , Rango del Movimiento Articular , Hueso Trapecio/lesiones , Hueso Trapezoide/lesiones , Resultado del Tratamiento , Traumatismos de la Muñeca/complicacionesRESUMEN
Hand injuries are a common complaint in the emergency department (ED). Oftentimes, these injuries occur in work settings. We report a case of a healthy EMS provider presenting to the ED with a left thumb injury that turned out to be an isolated trapezium subluxation.Using bedside fluoroscopy, the thumb carpometacarpal joint was isolated, injected, and subsequently reduced. The clinical course and management are discussed as well as a brief review of hand injuries.
Asunto(s)
Auxiliares de Urgencia , Traumatismos de los Dedos/etiología , Luxaciones Articulares/terapia , Traumatismos Ocupacionales/etiología , Procedimientos Ortopédicos/métodos , Adulto , Servicio de Urgencia en Hospital , Traumatismos de los Dedos/diagnóstico por imagen , Traumatismos de los Dedos/terapia , Humanos , Luxaciones Articulares/etiología , Masculino , Radiografía , Hueso Trapecio/lesionesRESUMEN
PURPOSE: To investigate whether volar percutaneous screw fixation of scaphoid waist fractures via a transtrapezial approach causes degenerative changes at the scaphotrapezial (ST) joint at short- to medium-term follow-up. METHODS: A total of 34 patients were available for follow-up at a mean of 6.1 years (minimum follow-up, 3.7 y) after volar percutaneous fixation of acute scaphoid waist fractures via a transtrapezial approach. The clinical follow-up examination included assessment of pain using a visual analog scale, range of motion, grip strength, and key pinch strength. We obtained radiographs of both hands in 3 views. We staged degenerative changes at the ST joint according to the modified Eaton and Glickel classification. RESULTS: The modified Mayo wrist score showed excellent clinical results using the described technique. One patient showed asymptomatic unilateral stage 2 osteoarthritic changes at the ST joint. We noted 6 screw protrusions, which required screw removal in 2 patients, in the early stages of use of the transtrapezial technique. One patient was treated surgically for a bone cyst. CONCLUSIONS: Volar percutaneous screw fixation of nondisplaced scaphoid waist fractures using a transtrapezial approach does not lead to symptomatic scaphotrapezial osteoarthritis at short- to medium-term follow-up. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
Asunto(s)
Tornillos Óseos , Fijación Interna de Fracturas/efectos adversos , Fracturas Óseas/cirugía , Osteoartritis/etiología , Hueso Escafoides/lesiones , Adolescente , Adulto , Anciano , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Fijación Interna de Fracturas/métodos , Curación de Fractura/fisiología , Fracturas Óseas/diagnóstico por imagen , Fuerza de la Mano , Humanos , Puntaje de Gravedad del Traumatismo , Masculino , Persona de Mediana Edad , Osteoartritis/diagnóstico por imagen , Osteoartritis/fisiopatología , Dimensión del Dolor , Placa Palmar/cirugía , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/fisiopatología , Radiografía , Rango del Movimiento Articular/fisiología , Estudios Retrospectivos , Medición de Riesgo , Hueso Escafoides/cirugía , Factores de Tiempo , Hueso Trapecio/lesiones , Hueso Trapecio/cirugía , Traumatismos de la Muñeca/diagnóstico por imagen , Traumatismos de la Muñeca/cirugía , Adulto JovenRESUMEN
We report a case of a carpometacarpal joint dislocation of the thumb associated with trapezium and Bennett's fractures. This combined injury pattern appears to be very rare. To our knowledge, no such case was found in the literature. The patient had open reduction internal fixation with pins and screws, with good functional outcome.
Asunto(s)
Articulaciones Carpometacarpianas/cirugía , Fijación Interna de Fracturas , Fracturas Óseas/cirugía , Luxaciones Articulares/cirugía , Pulgar/cirugía , Hueso Trapecio/cirugía , Adulto , Clavos Ortopédicos , Tornillos Óseos , Articulaciones Carpometacarpianas/lesiones , Fijación Interna de Fracturas/métodos , Fracturas Óseas/etiología , Humanos , Luxaciones Articulares/etiología , Masculino , Rango del Movimiento Articular , Pulgar/lesiones , Hueso Trapecio/lesiones , Resultado del TratamientoRESUMEN
Reports describing trapeziometacarpal joint fractures of the thumb have discussed Bennett's fracture or Rolando's fracture primarily. We report a patient with an unusual fracture which could not be classified as a Bennett's-type or Rolando's-type injury. The aetiology of the fracture pattern is proposed and treatment considerations are discussed.