Painful Snapping of Thumb Caused by a Displaced Non-Union Fragment from the Trapezium: A Case Report.

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.

Trapezium fracture: a common clinical mimic of scaphoid fracture.

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.

Trapezium nonunion: A rare case report.

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.

The Trapezium Dislocation: Case Presentation, Review of the Literature, Radiographic Analysis, Proposed Classification, and Treatment.

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.

Luxación trapeciometacarpiana aislada. Revisión bibliográfica / Isolated dislocation of the trapezio-metacarpal joint. Case Report

La luxación aislada de la articulación trapecio-metacarpiana es una entidad infrecuente. En gran parte es debido a tratarse de una articulación en encaje recíproco o en silla de montar, muy estable, con un fuerte complejo cápsulo-ligamentoso. Un mayor conocimiento anatómico de los ligamentos ha sido clave para abrir la discusión sobre cuál es el tratamiento ideal, cuál es más coste efectivo, cuál proporciona menor pérdida funcional y genera menor morbilidad. La mayor parte de los casos publicados se han resuelto mediante reducción cerrada con o sin fijación temporal con agujas de Kirschner, pero hay autores que proponen una reducción abierta y una reparación de los ligamentos. Llegar a la respuesta de esta pregunta es complicado, pues la mayor parte de las publicaciones sobre el tema se fundamentan en experiencias personales de un número reducido de casos. Con motivo de la presentación de un nuevo caso realizamos un análisis de los procedimientos terapéuticos propuestos para el tratamiento de la luxación aislada de la articulación trapecio-metacarpiana

Isolated dislocation of the trapezio-metacarpal joint is an infrequent entity. In large part it is due to a joint in reciprocal lace or saddle, very stable, with a strong capsule-ligamentous complex. Greater anatomical knowledge of the ligaments has been key to open the discussion about which is the ideal treatment, which is more cost effective, which provides less functional loss and generates less morbidity. Most of the published cases have been resolved by closed reduction with or without temporary fixation with Kirschner wire, but there are authors who propose an open reduction and repair of the ligaments. Getting to the answer to this question is complicated, since most of the publications on the subject are based on personal experiences of a reduced number of cases. On the occasion of the presentation of a new case, we performed an analysis of the proposed therapeutic procedures for the treatment of isolated dislocation of the trapezio-metacarpal joint

Efectos de la técnica de liberación por presión del punto gatillo miofascial latente del musculo trapecio superior: ensayo clínico aleatorio controlado / No disponible

Introducción: Los puntos gatillo miofasciales latentes (PGML) son responsables de dolor intenso y espontáneo. La cervicalgia mecánica no traumática se caracteriza por la presencia de hiperalgesia a la presión en la columna cervical, la cual afecta de igual manera a los músculos cervicales, como trapecios superiores, puesto que estos músculos reciben su inervación de los niveles C2-C4. Objetivo: Conocer los efectos inmediatos de la técnica de liberación por presión del PGML del trapecio superior en el umbral de dolor a la presión (UDP) de este músculo, así como del músculo angular del omoplato, del nervio occipital mayor (NOM), del nervio supra-orbitario (V1) y de las apófisis articulares de C3-C4 bilateralmente, y en la amplitud del movimiento activo cervical (AMAC). Material y métodos: Sesenta sujetos diagnosticados de PGML en las fibras más antero-superiores del músculo trapecio superior fueron incluidos en el estudio. Los valores del UDP se midieron bilateralmente en trapecio superior angular del omoplato, NOM, V1 y apófisis articulares de C3-C4 mediante un algómetro digital. La AMAC en flexión, extensión, latero-flexión homolateral, latero-flexión contralateral, rotación homolateral y rotación contralateral se midieron con un inclinómetro de burbuja. Al grupo intervención se le aplicó la técnica de liberación del PGM, y al grupo control se le aplicó una técnica placebo con ultra-sonidos sin intensidad. Resultados: Los resultados obtenidos demuestran que la técnica de liberación por presión del PGML del trapecio superior es efectiva en el aumento del UDP en este músculo inmediatamente después de su aplicación (p<0,01). Se verificó, además, que el aumento del UDP en el trapecio superior, tras la liberación del PGML, fue acompañado de un aumento simultáneo del UDP en el trapecio superior contralateral, así como en el músculo angular del omoplato bilateralmente, NOM bilateralmente, apófisis articulares de C3-C4 bilateralmente y V1 homolateral. En ambos grupos se verificó un incremento significativo de la AMAC (p<0,01). Sin embargo, en el grupo de intervención este aumento fue significativamente superior, lo que del punto de vista clínico puede ser bastante relevante. Conclusiones: La técnica de liberación por presión en el PGML del trapecio superior es una técnica útil en osteopatía, siendo efectiva en el aumento del UDP y de la AMAC inmediatamente después de su aplicación

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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.

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.

Single-incision open reduction and internal fixation of comminuted trapezium fractures with distal radius cancellous autograft.

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.

Carpometacarpal dislocation of the thumb associated with fracture of the trapezium.

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.

Using a TightRope® to treat a complex fracture of the trapezium.

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.

Fractura periprotésica de trapecio en paciente con artroplastia trapecio-metacarpiana no cementada. A propósito de un caso y revisión bibliográfica / Periprosthetic Fracture of Tapeze in Patients with arthroplasty Trapeze - Metacarpal uncemented. A Purpose of a case and Review Bibliografica

Presentamos el caso de una paciente de 49 años de edavresentaba un estadio III, implantándose una artroplastia trapecio- metacarpiana (TPZMTC) no cementada cuyo control radiológico postoperatorio fue correcto. La evolución fue favorable hasta el segundo mes, a partir del cual empezó con episodios de dolor intenso acompañados de inflamación en la raíz del primer radio y presentando a nivel radiológico una fractura del trapecio. En la siguiente consulta de revisión postquirúrgica, se confirmó mediante una TAC la movilización de la prótesis trapecio - metacarpiana por estallido del trapecio e impactación en la base del escafoides. Debido a esto hubo que someter a la paciente a una nueva intervención para la retirada de la prótesis y realización de una artroplastia de suspensión. Palabras claves: rizartrosis, artoplastia trapecio, complicaciones prótesis trapecio - metacarpianas

We report the case of a 49 year old woman with bilateral rizarthrosis Eaton stage II . At fi rst time she was operated of the right hand on which an extension and abduction osteotomy of the fi rst metacarpal was performed successfully. One year later she had surgery on his left hand, which had worsened and had Eaton stage III, implanting an trapezium arthroplasty - metacarpal ( TPZMTC ) cementless whose postoperative radiological control was correct. The outcome was favorable until the second month, after which began with episodes of severe pain accompanied by infl ammation at the root of the fi rst ray and radiologically presenting a fracture of the trapezium. The following review of postsurgical consultation was confi rmed by a CT mobilizing prosthesis trapezium - metacarpal and the trapezium burst impaction at the base of the scaphoid. Because of this it was necessary to subject the patient to a new surgery for removing the prosthesis and performing a suspension arthroplasty

Carpal fractures.

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.

Sonography of trapezial ridge fractures.

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).

[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 trapezium subluxation in EMS provider with a novel reduction technique.

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.

Incidence of scaphotrapezial arthritis following volar percutaneous fixation of nondisplaced scaphoid waist fractures using a transtrapezial approach.

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.