fig-001: Plain radiograph of right hand post injury showing trapezium fracture and carpometacarpal dislocation.

Mentions: A 27-year-old British Caucasian man presented to the Accident and Emergency department after falling on his extended right thumb while playing football. On clinical examination his right thumb was swollen and tender at the base of the first metacarpal with no tenderness in the anatomical snuff box. Movement of the thumb was limited secondary to pain and he was neurovascularly intact distally. Plain radiographs (Figure 1) revealed a vertical fracture of the trapezium with associated dislocation of the first carpometacarpal joint. This dislocation was reduced under analgesia and entonox in the department (Figure 2) and he was placed in a scaphoid plaster and referred to the fracture clinic. On review in the fracture clinic 2 days later it was decided that given the articular involvement associated with the injury, better anatomical reduction and stabilisation would be required. He was listed for surgical treatment which occurred 4 days post the initial date of his injury. He underwent closed manipulation of the fracture under anaesthesia until good position of the articular margin was achieved and this was fixed with 2 Kirschner-wires inserted under Image intensification via the edge of the anatomical snuff box to avoid injury to the radial artery. Check images were satisfactory (Figure 3). The joint was stable clinically and he was placed in plaster including the thumb. Check images at 8 weeks were satisfactory. The Kirschner-wires and plaster were removed and physiotherapy commenced. At 3 month (Figure 4) and 6 month follow-up the patient reported good functional outcome. Though we did not formally score his function, he reported satisfactory return to all his normal activities of daily living including writing, dressing and lifting. He had satisfactory grip strength and good range of movement of the thumb with minimal pain.

Ramoutar DN, Katevu C, Titchener AG, Patel A - Cases J (2009)

Bottom Line: Trapezium fractures are rare injuries which should not be missed.We report a case of a 27-year-old right hand dominant man who sustained a closed vertical trapezium fracture and first carpometacarpal joint dislocation which was treated with closed reduction and percutaneous Kirschner-wire fixation, a technique familiar to all orthopaedic surgeons.Satisfactory functional outcome was achieved at final follow-up.

Affiliation: Department of Trauma and Orthopaedics, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Derby Road,Nottingham, NG7 2UH, UK. darryl.ramoutar@doctors.org.uk

Abstract: Trapezium fractures are rare injuries which should not be missed. We report a case of a 27-year-old right hand dominant man who sustained a closed vertical trapezium fracture and first carpometacarpal joint dislocation which was treated with closed reduction and percutaneous Kirschner-wire fixation, a technique familiar to all orthopaedic surgeons. Satisfactory functional outcome was achieved at final follow-up.