Isolated fractures of the trapezoid as a sports injury

Abstract

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.

Approach to Isolated Trapezoid Fractures

“…To date, very few articles have been published in English on isolated trapezoid fracture; information is derived exclusively from case reports. 3,6,[8][9][10][11][12][13][14][15][16][17] (We found 5 non-English reports of isolated trapezoid fracture. [18][19][20][21][22] ) The cause for the infrequency of this diagnosis is yet to be determined, but possible underlying reasons include underdiagnosis by providers or low incidence because of strict anatomic positioning.…”

“…16,23 In instances of metacarpal flexion or a volarly directed force, an axial load can cause a dorsal shear fracture of the trapezoid with concomitant dorsal subluxation of the second metacarpal at the carpometacarpal joint. 8,10 Another frequently reported cause is direct high-energy trauma that often results in fractures involving the surrounding carpal bones and metacarpals. 9,12,14 Isolated trapezoid fractures are extremely rare, and to date, only 7 cases (including Patient 2 in this article) of isolated trapezoid injuries directly related to sports injuries have been reported.…”

Trapezoid and Triquetrum Fracture: Report of a Rare Fracture Pattern

“…The trapezoid fractures are rarely seen among carpal fractures with 0.4% frequency [1]- [3] [5]. Axial loading is accused through the second metacarpal base.…”

“…Triquetrum fractures are the second least common fractures among carpal bones [1]- [3]. The trapezoid bone is located in the 2nd metacarpal, trapezium, capitate and scaphoid bones and is firmly connected to them, without any possibility of movement [4].…”

A Delayed Diagnosis of an Isolated Trapezoidal Fracture due to Direct Trauma: A Case Report

“…However, this incidence includes compound fractures, and isolated trapezoid injuries are even rarer. Blomquist et al [8] investigated 64 cases of trapezoid fractures. In their series, 95% of the fractures were combined with other wrist injuries, and the three cases of isolated trapezoid fractures represented only 4.7% of the total number of trapezoid fractures.…”