Palmar dislocation of the trapezoid

Koenig, Titus R.; West, Clark O.

doi:10.1007/s00256-002-0590-0

Cited by 11 publications

(15 citation statements)

References 13 publications

(41 reference statements)

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“…1,4,16,17 Palmar dislocations of the trapezoid appear to be less common than dorsal dislocations because the palmar ligamentous attachments of the trapezoid are stronger than the dorsal ligaments. 12,13 Similar to our case, injury isolated to the STT with maintained relationship of the trapezoid and second metacarpal appears to be a less common variant that has been described infrequently in previous studies. 18 Due to the high-energy nature of these injuries, associated soft tissue injury frequently occurs.…”

Section: Discussionsupporting

confidence: 85%

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Dorsal Dislocation of the Trapezoid at the Scaphotrapeziotrapezoidal Joint

2015

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Background Axial dislocations of the trapezoid are rare, high-energy injuries. We present an unusual case of isolated dorsal dislocation of the trapezoid and index metacarpal at the scaphotrapeziotrapezoidal (STT) joint due to steering wheel injury. Case Description A 56-year-old man presented to our office with right hand pain for 10 days after a head-on motor vehicle accident (MVA) in which he suffered an axial load injury to his hand on the steering wheel. X-ray images were reported as unremarkable. Further workup with computed tomography (CT) scan revealed an isolated dorsal dislocation of the trapezoid with its associated index metacarpal at the STT joint. The patient was treated with open reduction, pinning, and dorsal capsulodesis. Literature Review Dorsal dislocation of the trapezoid has been associated with high-energy trauma such as industrial accidents or motorcycle accidents; however, recent case reports have also revealed an axial loading mechanism from a steering wheel injury as an increasingly common mechanism. These cases typically occur concomitantly with other fractures or dislocations of the carpal bones or carpometacarpal (CMC) joints. Multiple reports of delayed diagnoses due to distracting injuries and difficulty of recognition on plain radiographs have been reported. Clinical Relevance Dorsal dislocation of the trapezoid with its associated second metacarpal is a rare, high-energy injury that can often be missed on plain radiography. We report a rare variant with no concomitant injury to the metacarpals or carpal bones. A low index of suspicion for further imaging should exist in the setting of an axial loading injury to the hand.

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Section: Discussionsupporting

confidence: 85%

“…11 Dorsal dislocation is most common, although volar dislocations have been described. 12,13 Reports of trapezoidal dislocations have been isolated to case reports or small (<5 patient) case series, and isolated injuries represent the most uncommon variant of these cases.…”

mentioning

confidence: 99%

Dorsal Dislocation of the Trapezoid at the Scaphotrapeziotrapezoidal Joint

2015

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“…Isolated dislocation of the trapezoid may similarly occur in a volar [7, 19, 22, 23, 25, 51] or dorsal [1, 6, 11, 13, 29–31, 35, 41, 42, 44, 47] direction. The trapezoid has a predisposition for dorsal dislocation due to exposure of the dorsal surface of the trapezoid during wrist extension, the constraints of the bony anatomy (particularly of the scaphoid) when the wrist is in dorsiflexion, and the presence of weaker ligaments dorsally than palmarly [1, 22, 29–31, 38, 42, 44]. A mechanism for dorsal dislocation of the trapezoid due to a blow to the distal dorsal end of the second metacarpal with the wrist in slight flexion has been proposed [6, 29–31, 47].…”

Section: Discussionmentioning

confidence: 99%

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

Clarke

Raphael

2009

Hand (New York, N,Y.)

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“…Wright and Umaar 8 describe "the missing carpal sign" as evidence of dorsal trapezoid dislocation, but this can be particularly challenging to evaluate in the setting of concomitant metacarpal dislocations. In their review, Koenig and West 9 found that a third of all trapezoid dislocations in the literature are missed on initial presentation. Broadbent et al 2 describe a case of trapezoid dislocation identified only on postoperative CT scan following fixation of CMC joints that required a return to the operating room for reduction.…”

Section: Journal Of Wrist Surgerymentioning

confidence: 99%

Dorsal Dislocation of the Trapezoid with Metacarpal Instability: A Boxing Injury

2020

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Background The second and third metacarpals are firmly attached, immobile structures which for the stable pillar of the hand. The trapezoid has been described as the keystone of the wrist, allowing a wide range of functional motion as well as inherent anatomic and biomechanical stability to the carpus. Case Description We describe a novel boxing injury with a 180-degree in situ dislocation of the right trapezoid with concomitant second and third carpometacarpal (CMC) joint dislocations. Open anatomic reduction of the trapezoid was obtained, and subsequent percutaneous pinning of the metacarpals allowed for a full functional recovery and return to sports at 6 months. Literature Review Combined trapezoid and CMC dislocations are extremely rare and have only been previously described in high-energy mechanism injuries, involving a direct dorsal force such as from the steering wheel in a motor vehicle collision. There are no previous reports of this injury occurring in the setting of direct axial load along the metacarpals in a clenched fist such as in a punch or fighting injury. Clinical Relevance The rare nature of this combined injury, its novel mechanism, and the difficulty in interpreting acute injury and postreduction radiographs require that the treating physician have a high degree of clinical suspicion for associated injuries when CMC dislocations are identified. Treatment strategies incorporating intraoperative fluoroscopy, open anatomic reduction of the trapezoid under direct visualization along with closed reduction, and pinning of the metacarpals reestablish carpal stability and provide excellent long-term results.

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Palmar dislocation of the trapezoid

Cited by 11 publications

References 13 publications

Dorsal Dislocation of the Trapezoid at the Scaphotrapeziotrapezoidal Joint

Dorsal Dislocation of the Trapezoid at the Scaphotrapeziotrapezoidal Joint

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

Dorsal Dislocation of the Trapezoid with Metacarpal Instability: A Boxing Injury

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