J Korean Fract Soc.  2009 Oct;22(4):276-282. 10.12671/jkfs.2009.22.4.276.

Operative Treatment of Trapezium Fractures

• Kang HJ
• Seol NH
• Heo MS
• Hahn SB

• KMID: 1469995
• DOI: http://doi.org/10.12671/jkfs.2009.22.4.276

Abstract

PURPOSE
Fractures of trapezium are uncommon carpal bone fractures and often unrecognized lesions. We investigated about operative treatment of trapezium fracture. MATERIALS AND METHODS: Seven patients with fractures of trapezium were evaluated after surgical treatment with a mean follow up time of 18 months (12 months~3 years). Functional assessment (pain, limitation in activities of daily living, satisfaction), physical examination (range of motion, grip strength), and radiographic evaluation were performed. Traumatic arthritis and carpometacarpal joint subluxation were confirmed by radiograph. RESULTS: During study period, 122 cases were carpal bone fractures, and seven of 122 cases were fractures of trapezium. All cases were intra-articular fractures of trapezium. 1st carpometacarpal joint dislocation at 4 patients, Bennett's fracture at 1 patient, hamate hook fracture at 1 patient, and base of 4th proximal phalanx fracture at 1 patient were associated with fracture of trapezium. Open reduction and internal fixation were performed at 6 cases and 1st carpometacarpal joint arthrodesis was performed at 1 case because of neglected fracture. One of 6 cases which were performed to open reduction and internal fixation was reoperated to external fixation due to reduction loss. Clinically 6 patients revealed good results. one of 7 patients experienced limitation of thumb opposition. CONCLUSION: Based on the good results obtained with surgical intervention, we advocated open reduction and internal fixation for fractures with intraarticular depressed more than 2 mm or combined with Bennett's fracture or carpometacarpal subluxation.

Keyword

Carpal bone; Trapezium fracture; Open reduction and internal fixation

MeSH Terms

Activities of Daily Living
Arthritis
Arthrodesis
Carpal Bones
Carpometacarpal Joints
Dislocations
Follow-Up Studies
Hand Strength
Humans
Intra-Articular Fractures
Physical Examination
Thumb

Figure

• 

  Fig. 1 (A, B) Radiograph and CT show communited depressed fracture of trapezium. (C) Immediate postoperative radiograph shows internal fixation with 2 K wires and 1 mini screw. (D) Anteroposterior radiograph of postoperative 5 weeks shows reduction loss and carpometacarpal subluxation. (E) Intraoperative photograph shows open reduction using external fixator. (F) Immediate postoperative radiograph shows open reduction and pinning and external fixation. (G) Anteroposterior radiograph of postoperative 21 months shows traumatic arthritis.

• 

  Fig. 2 (A, B) Radiograph shows communited fracture of trapezium and Bennett's fracture. (C) Immediate postoperative radiograph shows internal fixation with 6 K wires and 1 mini screw. (D) Anteroposterior radiograph of postoperative 3 months shows good union status.

• 

  Fig. 3 (A) CT shows fracture of trapezium and carpometacarpal joint degenerative arthritis and osteophyte formation. (B) Immediate postoperative radiograph shows carpometacarpal joint fusion with Acutrak screw. (C, D) Radiograph and CT show nonunion of carpometacarpal joint fusion. (E, F) Radiograph of second postoperative 2 months shows good union status.

Reference

1. Binhammer P, Born T. Coronal fracture of the body of the trapezium: a case report. J Hand Surg Am. 1998; 23:156–157.

2. Buchler U, McCollam SM, Oppikofer C. Comminuted fractures of the basilar joint of the thumb: combined treatment by external fixation, limited internal fixation, and bone grafting. J Hand Surg Am. 1991; 16:556–560.

3. Checroun AJ, Mekhail AO, Ebraheim NA. Radial artery injury in association with fractures of the trapezium. J Hand Surg Br. 1997; 22:419–422.

4. Choi JY, Shin HK, Son KM, Ko CS. Operative treatment in fracture-dislocations of carpometacarpal Joints. J Korean Fract Soc. 2005; 18:443–451.

5. Cordrey LJ, Ferrer-Torells M. Management of fractures of the greater multangular. Report of five cases. J Bone Joint Surg Am. 1960; 42:1111–1118.

6. Eaton RG, Lane LB, Littler JW, Keyser JJ. Ligament reconstruction for the painful thumb carpometacarpal joint: a long term assesment. J Hand Surg Am. 1984; 9:692–699.

7. Eaton RG, Littler JW. Ligament reconstruction for the painful thumb carpometacarpal joint. J Bone Joint Surg Am. 1973; 55:1655–1666.

8. Foster RJ, Hastings H 2nd. Treatment of Bennett, Rolando, and vertical intraarticular trapezial fractures. Clin Orthop. 1987; 214:121–129.

9. Howard FM. Fractures of the basal joint of the thumb. Clin Orthop Relat Res. 1987; 220:46–51.

10. Jones WA, Ghorbal MS. Fractures of the trapezium. A report on three cases. J Hand Surg Br. 1985; 10:227–230.

11. Kjaer-Petersen K, Langhoff O, Andersen K. Bennett's fracture. J Hand Surg Br. 1990; 15:58–61.

12. Livesley PJ. The conservative management of Bennett's fracture-dislocation: a 26 year follow-up. J Hand Surg Br. 1990; 15:291–294.

13. McGuigan FX, Culp RW. Surgical treatment of intra-articular fractures of the trapezium. J Hand Surg Am. 2002; 27:697–703.

14. Pellegrini VD Jr, Olcott CW, Hollenberg G. Contact patterns in the trapeziometacarpal Joint: the role of the palmar beak ligament. J Hand Surg Am. 1993; 18:238–244.

15. Pointu J, Schwenck JP, Destree G. Fractures of the trapezium. Mechanism, pathology and indications for treatment. French J Orthop Surg. 1988; 2:380–391.

16. Rockwood CA, Wilkns KE, Beaty JH. Fractures in children. 4th ed. Lippincott Co;1996. p. 103–122.

17. Salter RB, Harris WR. Injuries involving the epiphyseal plate. J Bone Joint Surg Am. 1963; 45:587.

18. Timmenga EJ, Blokhuis TJ, Maas M, Raaijmakers EL. Long term evaluation of Bennett's fracture. A comparison between open and closed reduction. J Hand Surg Br. 1994; 19:373–377.

19. Yi JW, Chung WY, Lee WS, Park CY, Heo YM. Fracture-dislocation of the carpometacarpal joint with the fracture of hamate. J Korean Fract Soc. 2008; 21:297–303.