Trapezium Fracture Associated with Thumb Carpometacarpal Joint Dislocation: A Report of Three Cases and Literature Review

Abstract

Isolated trapezium fracture in combination with thumb carpometacarpal (CMC) joint dislocation is extremely rare, and no treatment consensus exists. Herein, we report 3 successfully treated cases of isolated trapezium fracture with thumb CMC joint dislocation. While good short-term results have been reported in the literature, the possibility of substantial ligament injuries that can lead to future instability of the thumb CMC joint must be noted. In order to obtain an excellent long-term clinical result, we propose the consideration of the anatomical repair of the CMC joint in terms of both bony and ligamentous structures in cases where instability remains after fracture fixation.

Isolated comminuted trapezium fracture: A case report and literature review

“…The saddle shape of the trapeziometacarpal joint and its stabilizing ligaments, including the anterior oblique ligament, posterior oblique ligament, intermetacarpal ligament, and dorsoradial ligament, have a role in providing the first ray with adequate mobility and stability needed for performing activities of everyday life delicately [ Fig. 4 ] [ 6 , 7 ].

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“…Type 4 and 5 involve both joints and have a worse prognosis. Most reported cases belong to type 2a,2b, and 4 [ 6 , 12 ]. However, our patient had a comminuted fracture (type 5).…”

“…They advocated ORIF with or without graft to restore articular surface [ 3 ]. Kohyama et al also used ORIF (via a lateral approach) for treating comminuted trapezium fractures [ 6 ].…”

The Uncommon Trapezium Fracture: A Case Series

“…Even after early diagnosis and treatment, up to 45% of the patients have osteoarthritis. 19 Our case series shows different types of trapezium fractures according to the Walker's classification. Trapezium fractures can be treated conservatively as well as operatively, depending on the kind of fracture.…”

“…18 The first CMC joint is saddle shaped and stabilized by 16 surrounding ligaments, while the scapho-trapezium-trapezoid (STT) joint is stabilized by the STT ligamentous complex that consists of four components: the scapho-trapezial ligament (main stabilizer), scapho-capitate ligament, palmar capsule, and dorsal capsule. 19 The blood supply to the trapezium is guaranteed by two separate extraosseous systems. The branches from the radial artery directly supply the palmar, posterior and lateral surfaces, and branches of the recurrent radial artery supply the palmar surface.…”