Approach to Isolated Trapezoid Fractures

Abstract

Background: The trapezoid is the least commonly fractured carpal bone, comprising 4% of all carpal fractures. To date, few articles have been published on isolated trapezoid fractures. Mechanisms of injury have typically been reported as an axial load, with or without forced wrist flexion/extension, that is transmitted from the second metacarpal indirectly to the trapezoid. Case Reports: Two patients presenting with symptoms of nonspecific wrist pain after acute trauma were initially worked up with plain film x-rays. Physical examinations identified nonspecific wrist pain in both patients. Mechanisms of injury involved direct trauma and an axial force transmitted through the scaphoid region of an extended wrist in each patient. Plain x-rays were negative for trapezoid fracture in both patients. Computed tomography and magnetic resonance imaging revealed the diagnoses. Conservative management consisted of splinting and immobilization, with full recovery reported at 2.5-and 3-month follow-up. Conclusion: Isolated fractures of the trapezoid require a high index of suspicion as they are rare, and localizing signs and symptoms are typically vague and may mimic those of scaphoid fractures. When athletes present with dorsal wrist pain, swelling, and snuffbox tenderness in the setting of negative plain x-rays, the most likely mechanisms of injury are associated with athletic activity. Treatment depends on the degree of displacement and other associated injuries and ranges from activity modification or immobilization to open reduction with internal fixation.

Trapezoid Stress Fracture in an Olympic-Level Gymnast

“…Despite strict adherence to proper form, rates of injury in gymnasts tend to increase at higher levels of competition because of the intensity of training 2 . Trapezoid fractures occur through an axial load through the second metacarpal with or without forced wrist flexion and extension 1 . Performance of gymnastic activities can generate forces up to 16 times the body weight and increase the risk of injuries such as trapezoid fracture 11 .…”

“…Fractures of carpal bones, other than the scaphoid, are uncommon. Fractures of the trapezoid represent less than 1% of all carpal fractures 1 . There are case reports of various carpal stress fractures resulting from athletics (Table I).…”

“…Wrist injuries are particularly common in gymnastics due to the upper extremity weight-bearing that is experienced 3 . Although acute fractures of the trapezoid in athletes have been reported 1,4,5 , there has only been one description of a trapezoid stress fracture in a shotput athlete 6 . In this case report, we discuss a stress fracture of the trapezoid sustained in an Olympic-level gymnast who was treated nonsurgically with an excellent outcome.…”

Displaced isolated coronal shearing fracture of the trapezoid: a case report

“…The mechanism of an isolated trapezoid fracture is mostly an axial or flexion force transmitted through the second metacarpal [4,9]. Miyawaki et al [10] explained the mechanism of traumatic trapezoid injury as a sudden, excessive wrist dorsiflexion that exerts indirect stress on the trapezoid.…”

“…The mechanism of an isolated trapezoid fracture is mostly an axial or flexion force transmitted through the second metacarpal [ 4 , 9 ]. Miyawaki et al.…”