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Trapezium Fracture

ICD-9 Classification / Treatment
Etiology / Epidemiology / Natural History Associated Injuries / Differential Diagnosis
Anatomy Complications
Clinical Evaluation Follow-up Care
Xray / Diagnositc Tests Review References

synonyms:

Trapezium Fx ICD-9

  • 814.05 (closed fracture of trapzium , larger multangular)
  • 814.06 (closed fracture of trapezium, smaller multangular)
  • 814.15 (open fracture of trapezium, larger multangular)
  • 814.16 (open fracture of trapezium, smaller multangular)

Trapezium Fx Etiology / Epidemiolgy / Natural History

  • uncommon: generally from high energy trauma, MVA
  • Natural History: displaced fractures can lead to permanent limitations in pinch and grip strength as well as post-traumatic arthritis

Trapezium Fx Anatomy

  • See also Wrist anatomy.

Trapezium Fx Clincal Evaluation

  • tenderness and swelling localized to trapeziometacarpal joint / base of thumb
  • Motion may be pain free in trapezial ridge fractures, but pinch strength will be weakened and/or painful

Trapezium Fx Xray

  • Standard P/A, lateral and oblique views of the wrist
  • Bett's view: beam is directed toward trapeziometacarpal/scaphotrapezial joints with wrist pronated and hypothenar emminence resting on the cassette.
  • Carpal Tunnel view
  • Consider getting comparison views of normal wrist, or CT scan if diagnosis is not definitive on plan films.

Trapezium Fx Classification/Treatment

  • Vertical split: Generally found to be comminuted at surgery
  • Trapezial Ridge Fx: Type I occur at the base of the ridge = thumb spica. Type II=tip of ridge=symptomatic treatment, can be excised if remains symptomatic(Palmer AK, J Hand Surg 1981;6:561-564)
  • Non-displaced fx = thumb spica cast for 4-6weeks
  • Displaced = articular displacement >2mm or carpometacarpal subluxation = ORIF with or without bone grafting. Fixation with k-wires, mini-fragment screws, Herbert screws, etc.

Trapezium Fx Technique

  • Antibiotic, tourniquet
  • 4-5cm longitudinal incision over radial wrist centered on trapezium
  • Identify and retract sensory branch of radial nerve ulnarly
  • Retract EPL and radial artery ulnarly
  • Retract APL and EPB palmarly
  • Incise capsule and expose trapezium
  • Irrigate hematoma, reduce fx generally with 0.045-in K-wire
  • Fixation with K-wires, mini-fragment screws, Acutrak screw, or Herbert screws
  • Irrigate
  • Close in layers
  • Thumb spica splint

Trapzium Fracture Associated Injury / Differential Diagnosis

Trapzium Fx Complications

  • continued pain, weakness in pinch and progessive degenerative changes may occur even after union. Consider LRTI for refractory cases.
  • Radial artery, sensory branch of radial nerve injury
  • malunion, nonunion
  • post-traumatic arthritis

Trapzium Fx Follow-Up

  • Post-Op: Place in volar splint. Encourage digital ROM, elevation.
  • 7-10 Days: remove splint. Place in short arm thumb spica cast. Consider removable splint with gentle ROM if fixation was extremely secure.
  • 6 Weeks: Cast removed. Check xrays. Started gentle ROM exercises. Activity modifications: no heavy manual labor, no contact sports, no lifting >5 lbs.
  • 3 Months: Check xrays. If union is complete return to full activities.

Trapzium Fx References

  • McGuigan FX, Culp RW, Surgical Treatment of Intra-articular Fractures of the Trapezium, J Hand Surg 2002;27A;697
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