Bennett’s fracture associated with fracture of Trapezium - A rare injury of first carpo-metacarpal joint

Arthroscopic Assisted Treatment of Combined Trapezium and Bennett Fracture-Dislocation

Trapezium fractures are unusual; however, they represent the third most frequent fracture of the carpal bones. As they usually follow a high-energy trauma, they are associated with distal radius, Bennett, or Rolando fractures in 80% of cases. Traditional treatment options include, closed reduction and percutaneous pinning, or open reduction and internal fixation. To minimize the additional surgical trauma, an arthroscopic technique has been developed for safe, minimally invasive management of complex injuries of the first carpo-metacarpal joint. Intra-articular dislocated fracture fragments are reduced under direct visualization and fixed through small incisions. Limiting additional surgical damage on the carpo-metacarpal joint ligaments, capsule, and other soft tissues around the fracture preserves the blood supply to fracture fragments and also the proprioceptive system, which is key for the dynamic stability of such a hypermobile joint. This report confirms that the procedure is feasible, and a complete functional recovery can be expected with reduced postoperative rehabilitation.

Combined Bennett Fracture Dislocation and Trapezium Fracture: A Rare Case Report

The combination of Bennett fracture dislocation and trapezium fracture is rare and presents a diagnostic and therapeutic challenge. We report a case of a young adult male who presented with such an injury after a motor vehicle accident. He had a Bennett fracture with a vertical trapezium fracture. He was treated with K-wire fixation without a capsulotomy. The fracture healed in six weeks and at eight weeks, he regained full movement. The mechanism of this rare injury pattern is discussed. A simple modification of a commonly used treatment method resulted in faster fracture healing and recovery in the present case. The case is presented for its rarity and the modified treatment method. Higher suspicion is stressed to avoid missing the diagnosis.

Trapezium fracture: a common clinical mimic of scaphoid fracture

PURPOSE

Fractures of the trapezium are rarely diagnosed on plain radiographs after acute wrist trauma. High-resolution cross-sectional imaging identifies fractures of the trapezium as the most common radiographically occult carpal bone fracture. We review the fracture frequency, mechanisms and patterns of trapezium fractures.

METHODS

Cone beam CT was performed in patients with suspected radiographically occult radiocarpal fracture following acute injury. The frequency of carpal bone fractures was assessed and compared.

RESULTS

Ninety-three radiographically occult wrist fractures were identified in 166 patients with acute trauma and negative radiographs. The trapezium was the most frequently fractured carpal bone, making up 20.4% of wrist fractures. Seventy-nine percent of trapezium fractures involved the volar ridge. The scaphoid was the clinically suspected fractured bone at initial assessment in 84% of patients with trapezium fractures.

CONCLUSION

Fractures of the trapezium in acute wrist trauma are much more common than described in the literature. If initial radiographs are negative, a fracture of the trapezium is more likely to be present than one of the scaphoid, despite high levels of clinical suspicion for scaphoid injuries. Awareness of the types and mechanisms of trapezium fracture is important. Cross-sectional imaging should be considered in all cases of post-traumatic wrist pain with negative radiographs.