Carpal Bone Dislocations

Combined Dislocation of the Trapezium and the Trapezoid: A Case Report with Review of the Literature

“…Dislocation of the either the trapezium or the trapezoid are both rare injuries, even among carpal dislocations. Other injuries to the carpometacarpal joints, the radius, and the soft tissues have been described in association with both trapezium [3, 17, 21, 33, 34, 36, 48, 50] and trapezoid dislocations [5, 8, 9, 15, 27, 32, 33, 38, 41]. These injuries may be missed and require diligent radiographic evaluation.…”

“…Combined dorsal dislocation of the trapezium and the trapezoid in addition to multiple carpometacarpal joints has been reported, but in these cases, the articulation between the thumb and the trapezium remained intact [24, 27, 32, 33]. Dorsal dislocation of the trapezium with dorsal subluxation of the trapezoid has also been described [10], as has combined dorsal subluxation of the trapezium and the trapezoid [40].…”

“…Salvage procedures include excision of the trapezium or trapezoid, as well as limited arthrodesis [3, 15, 16, 18, 19, 22, 23, 31, 35, 42, 47, 51]. Open reduction with K-wire fixation of combined subluxation and dislocation of the trapezium and the trapezoid has been reported through a dorsal approach [24, 27, 32, 40]. In our case, it was felt that the instability to the wrist provided by the patient's combined trapezium and trapezoid dislocations with concomitant distal radius fracture warranted K-wire fixation.…”

“…Excision of either the trapezium or the trapezoid may result, not only in decreased wrist range of motion and grip strength, but also in proximal migration of the adjacent metacarpal [14, 26, 29, 36]. In addition to the deficits that may be encountered in treatment of isolated trapezium or trapezoid dislocations, open reduction of combined trapezium and trapezoid injuries may result in lateral carpal instabilities [24, 27, 32, 33].…”