Trapezoidal fractures: Overview and introduction of a novel diagnostic classification system.

INTRODUCTION: Trapezoidal fractures account for only 0.4% of all carpal bone fractures. Owing to their rarity, there is paucity in the literature regarding the clinical findings and treatment. This paper aims to summarize the current understanding of trapezoidal fractures and present a novel classification algorithm. METHODS: A diagnostic classification algorithm was created based on the known blood supply and ligamentous attachment of the trapezoid. The proposed treatment algorithm was then applied to trapezoidal fractures in the literature to validate the algorithm and determine whether patients received treatment that was in accordance. RESULTS: A total of 19 articles, representing 22 trapezoidal fractures were included, with two additional cases presented by the authors. Presenting symptoms were pain (n = 21) and swelling (n = 12). Diagnosis was made on CT in a majority of the time, 79.2% (n = 18). All outcomes were favorable with symptomatic resolution and full range of motion after treatment, except in four patients that had co-existing wrist injuries. When the algorithm was applied, 89.5% (n = 17) of the patients received treatment in accordance with the proposed algorithm and demonstrated good outcomes. In the remaining patients (n = 2) whose treatment differed, one had diminished grip strength and the other was lost to follow-up. CONCLUSIONS: Given a degree of clinical suspicion including a history of blunt trauma to the hand and persisting pain, trapezoidal fractures should remain on the differential when plain radiographs fail to identify any fracture. Operative treatment is suggested if there is any significant displacement, compromise of the dorsal surface, or breech of the trapezoidal ligaments causing possible dislocation. LEVEL OF EVIDENCE: IV - Diagnostic.

Isolated Trapezoid Fracture in a Boxer.

BACKGROUND Trapezoid fractures are very uncommon, accounting for less than 1% of all wrist fractures. Isolated fractures of this bone are even more rare, with just a few reports in the literature. The trapezoid bone has a very stable position within the wrist, forming a relatively immobile joint with the second metacarpal base distally. It is also connected by very strong ligaments to the trapezium, capitate and, scaphoid. Trapezoid fractures occur when a strong bending or axial force is applied to the second metacarpal base. CASE REPORT We present a clinical case of an isolated, non-displaced, trapezoid fracture in a young white male, which was treated with cast immobilization for 4 weeks and physical therapy. Complete functional recovery was achieved 3 months after the injury, without any pain or tenderness. CONCLUSIONS Fractures of the trapezoid bone usually have a good clinical outcome. Nonetheless, we need to be very suspicious about this diagnosis since radiography is apparently normal in almost all such cases and clinical examination results may not be entirely clear.

[Transtrapezoid carpal dislocation: a case report]. / Transtrapezoidale Luxation: Ein Fallbericht.

Fracture dislocations of the STT joint are extremely rare. We present the case of a 50-year-old worker, who sustained a crush injury of his left hand with a dorsal fracture dislocation of the trapezoid bone and the associated second metacarpal bone at the STT, and a concomitant compartment syndrome of the hand. The fracture was reduced immediately and compartment release was performed, followed by percutaneous stabilisation using three K-wires. Material removal after six weeks was followed by intensive physical therapy. At the final follow-up examination after three months, we observed a good recovery of hand function compared to the unaffected right side with 75 % grip strength, 90 % ROM in extension/flexion and full thumb opposition (Kapandji score 9/10). Immediate surgical treatment of this rare injury can lead to a good functional result of the hand.

Trapeziometacarpal joint dislocation complicated by a trapezium fracture: A case report and literature review.

The authors report and discuss the management of a 25-year-old male patient with a trapeziometacarpal joint dislocation complicated by a trapezium fracture. This injury combination is rare with only reported 15 cases. After closed reduction resulted in dorsal instability, anatomical reduction of the trapezium fracture and internal screw fixation were performed using an open approach. This fixation stabilized the joint but was fragile due to the small fragment size. For this reason, ligament reconstruction using half of the flexor carpi radialis tendon was added. At the last follow-up, 16 months later, the trapeziometacarpal joint was stable with a normal range of motion, but the patient had slight pain during physical effort and decreased pinch strength.

A rare combined injury of dorsal fracture-dislocation of four carpometacarpal joints and trapezium, trapezoid and distal radius bone fractures.

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.

Recurrent posttraumatic trapeziometacarpal joint dislocation in a child: A case report.

Traumatic trapeziometacarpal joint dislocation of the thumb accounts for less than 1% of all hand injuries. This injury is even less common in children. Optimal treatment strategies for this injury are still the subject of debate for both children and adults. We report a case of recurrent posttraumatic trapeziometacarpal joint dislocation in an eight-year-old girl. We believe our case is the first report of recurrent acute dislocation leading to chronic dislocation in the English medical literature. Restoring the anatomy and biomechanics of the trapeziometacarpal joint is essential when treating these injuries; for this reason, surgical treatment is usually indicated. Overall, the prognosis of trapeziometacarpal dislocation treated acutely is favorable and stable over time. However, the role of open surgery and ligament reconstruction remains controversial, especially in children.

Total carpometacarpal joint dislocation combined with trapezium fracture, trapezoid dislocation and hamate fracture.

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.

Various Diagnostic and Treatment Pitfalls of Combined Fracture Dislocations of Trapezoid and Multiple Carpometacarpal Joints.

We report a rare case of combined fracture dislocations of the trapezoid and multiple carpometacarpal joints that became chronic due to inappropriate treatments. Although an acceptable clinical result was obtained with limited intercarpal fusion, correct diagnosis and initial treatments including anatomical reduction and fixation for obtaining a good clinical result, are important for complex trapezoid injury.

[Trapeziometacarpal arthroscopy]. / Die Arthroskopie des Daumensattelgelenks.

OBJECTIVE: Trapeziometacarpal arthroscopy improves diagnostic and therapeutic options in pathologies of the carpometacarpal (CMC) I joint. INDICATIONS: Pathologic conditions of the CMC I joint which are not sufficiently diagnosed by X-rays or MRI. CONTRAINDICATIONS: Pathologic conditions of the CMC I joint in which trapeziometacarpal arthroscopy is not expected to make a contribution to diagnosis or therapy. SURGICAL TECHNIQUE: Trapeziometacarpal arthroscopy using a 1.9 mm arthroscope after instillation of physiological solution. POSTOPERATIVE MANAGEMENT: Thumb cast sparing the interphalangeal joint for 1 week, then functional therapy. RESULTS: Trapeziometacarpal arthroscopy improves diagnosis of CMC I pathologies and gives new therapeutic options, a field which is still rapidly expanding.

Dorsal dislocation of the trapezoid with carpo-metacarpal dislocations: a case report and a description of the "missing carpal sign" on radiographs.

BACKGROUND: A case report of dorsal trapezoid dislocation with index and middle carpometacarpal dislocation is described. OBJECTIVES: On review of the literature, this rare injury is often misdiagnosed on presentation, with difficulty in reviewing initial radiographs being a key factor. CASE REPORT: We present our case report of trapezoid dislocation and describe the "missing carpal sign" on radiographs as an aid to suspicion of diagnosis. CONCLUSION: Trapezoid dislocation is an often-overlooked diagnosis; we present a sign to increase suspicion of injury and hence promote further investigation.

Pressure distribution in carpometacarpal joint, due to step-off in operatively treated Bennett's fractures.

INTRODUCTION: The purpose of the current study was to investigate the effects of residual articular incongruity after Bennett's fracture on load distribution of the joint surface. Our aim was to investigate whether a residual joint step and the altered load distribution led to negative clinical outcomes or symptomatic degenerative osteoarthritis of the trapeziometacarpal joint. PATIENTS AND METHODS: Twenty-four patients were available for long-term follow-up examination and were contacted by phone, and they returned for follow-up examination. Computed tomography (CT) scans of both carpometacarpal (CMC) joints were performed. CT scans were taken in the sagittal plane of the forearms with a slice thickness of 0.625 mm for three-dimensional reconstruction. The CMC joints were analysed due to a residual step in the joint. Only patients with a residual step-off were included in this study. To determine the areas of maximum density in the joint, CT-osteoabsorptiometry was performed. RESULTS: Ten patients had the maximum loading area radial and two patients central. The second major position of mineralization was detected central in four patients, volar-ulnar in two patients, radial in one patient, dorso-radial in one patient, volar in one patient and volar-radial in two patients. CONCLUSION: Finally, no higher loading in the area of the beak fragment could be found. The Wagner technique, even if it results in a persistent 1-2-mm intra-articular step-off of the beak fragment, is still the favourable method for the treatment of Bennett's luxation fractures.

Isolated fractures of the trapezoid as a sports injury.

The aim of this work is to describe the radiographic findings of isolated trapezoid fractures and determine the utility of these findings in guiding treatment. A second aim is to heighten awareness of an uncommon sports-related injury that is often radiographically occult because of the lack of primary or overt secondary radiographic findings. A retrospective review of radiology reports at our institution from 2007 to 2010 was performed to identify isolated trapezoid fractures. Two musculoskeletal radiologists and one orthopedic hand surgeon reviewed the patient presentations, images, treatments, and outcomes of the patients' injuries. This project had institutional review board approval. We describe three patients who presented with isolated sports-related trapezoid fractures. Each patient was successfully treated with activity modification, cast immobilization, and/or surgery based on their specific radiographic findings. Isolated sports-related trapezoid fractures are rare injuries. Only one prior case report in the English literature exists. Treatment success in patients with trapezoid fractures depends upon the degree of activity modification, splint protection, and especially fragment displacement. We report the largest series to date of isolated trapezoid fractures, all of which resulted from sports participation, and we analyze the success of diagnostic and treatment interventions.

[Anterior traumatic axial disruption of the middle carpal joint. Case report with literature review]. / Séparation traumatique axiale de la médiocarpienne à déplacement palmaire. À propos d'un cas avec revue de la littérature.

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.

Isolated dislocation of the trapezoid.

Here we present a rare case of an isolated trapezoid dislocation secondary to a high-speed motor vehicle injury. In this case we highlight that the fact that these injuries are commonly missed on standard radiographs and management invariably requires open reduction and internal fixation.

Trapezoid fractures: report of 11 cases.

PURPOSE: Trapezoid fractures are rare. Mostly single cases reports appear in the literature. The purpose of this study was to review 11 patients treated for trapezoid fractures at our center. METHODS: We reviewed all trapezoid fractures that presented over the past 10 years at our institution. We reviewed case notes regarding mechanism of injury, fracture pattern, mode of diagnosis, and time to diagnosis and treatment. RESULTS: We treated 11 patients for trapezoid fractures over the 10-year period. A correct diagnosis was made in 5 cases on initial evaluation. Most trapezoid fractures were diagnosed on computed tomographic scan. The fracture plane was predominantly sagittal. Coronal fractures could not be diagnosed on plain radiographs. CONCLUSIONS: Fractures of the trapezoid should be suspected from the mechanism of injury, in particular, axial force, and from local tenderness. These fractures may be underdiagnosed. We recommend computed tomography rather than plain radiography alone in case of clinical suspicion. TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic IV.

Severe isolated trapezoid fracture: a case report.

Isolated trapezoid fractures are rare. We present a case of severe isolated trapezoid fracture associated with bone loss and proximal migration of the second metacarpal, which was treated successfully by open reduction and internal fixation with bone grafting and joint fusion.

Diagnostic accuracy of multidetector computed tomography for patients with suspected scaphoid fractures and negative radiographic examinations.

PURPOSE: The aim of this prospective study was to evaluate the diagnostic accuracy of multidetector computed tomography (MDCT) in detecting occult scaphoid fractures. MATERIALS AND METHODS: A total of 54 patients with a clinically suspected scaphoid fracture and negative initial conventional radiographs were evaluated with 64-row MDCT wrist examinations within 1 week of the trauma. The gold standard used was the diagnosis on MRI done within 1 week after MDCT. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MDCT were calculated. RESULTS: MRI showed a total of 22 fractures in 20 of 55 (36%) wrists. Fractures included 14 scaphoid and 8 other carpal bones. MDCT showed a total of 19 fractures in 17 of 55 (30%) wrists. Two isolated scaphoid fractures and one trapezium fracture were missed on MDCT. The sensitivity, specificity, PPV, and NPV of MDCT were 86%, 100%, 100%, and 91%, respectively. CONCLUSION: MDCT offers highly accurate results, especially concerning cortical involvement, and is a useful alternative in facilities lacking MRI.

Combined dislocation of the trapezoid and finger carpometacarpal joints-the steering wheel injury: case report.

Two cases of combined dorsal trapezoid dislocation and multiple finger carpometacarpal joint dislocations are described. In both cases, a common mechanism involved a head-on motor vehicle collision while the subjects held tightly to the steering wheel. The patients were treated with open reduction and pinning, with good short-term results.