EURORAD ESR

Case 2264

Comminuted fracture of the trapezium

Author(s)
Parlorio E
 
Patient
male, 35 year(s)

Clinical History

Acute wrist injury.

Imaging Findings

The patient complained of pain at the base of the thumb after a high-energy trauma (traffic accident). Standard radiographs of the wrist demonstrated a comminuted intraarticular fracture of the trapezium bone. Posteroanterior and semipronated oblique views are shown (Fig. 1).

Discussion

Isolated fractures of the carpal bones, excluding the scaphoid, are relatively uncommon (1). Trapezial fractures have been described in association with fractures of the scaphoid and hamate bones, Bennet's fracture-dislocation and common carpometacarpal joint dislocation; they are felt to be related to shearing forces (2). Isolated fractures are rare (3% of carpal fractures) (3) and can occur after hyperextension of the thumb or a fall on the abducted thumb. Trapezial fractures may involve either the body (4) or the volar ridge of the bone, and are often missed on standard plain radiographs. Comminutive fractures of the trapezium have also been described (5). At most institutions, oblique radiographs are included as part of the standard wrist exam to increase sensitivity to carpal fractures. The standard oblique view (external) is taken in the PA position with the hand in partial pronation. This radiographic projection optimally demonstrates the scaphoid, trapezium, the base of the first metacarpal and the intervening joint spaces. The carpal tunnel view is useful to detect fractures of the volar surface of the trapezium.

Final Diagnosis

Comminuted trapezial fracture
 

MeSH

  1. Carpal Bones [A02.835.232.087.144]
    The eight bones of the wrist: capitate bone, hamate bone, lunate bone (SEMILUNAR BONE), pisiform bone, SCAPHOID BONE, trapezium bone, trapezoid bone and triquetral bone.
  2. Fractures [C21.866.405]
    Breaks in bones or cartilage. (Stedman, 25th ed)
  3. Radiography [E01.370.350.700]
    Examination of any part of the body for diagnostic purposes by means of roentgen rays, recording the image on a sensitized surface (such as photographic film).

References

  1. [1]
    1. Resnick D, Kang HS.
    Elbow.
    In Resnick D, Kang HS (eds). Internal derangements of joints. Emphasis on MR imaging.
    WB Saunders Co, Philadelphia, pp 334-86 (1997).

  2. [2]
    2. Gilbert TJ, Cohen M.
    Imaging of acute injuries to the wrist and hand.
    Radiol Clin North Am. 1997 May;35(3):701-25.    .

  3. [3]
    3. Sarazin I.
    Fracturas y luxaciones del carpo (escafoides excluido).
    In Chevrot A. Diagn　stico por imagen de la muကeca y de la mano.
    Masson, Barcelona, pp 107-18 (2000).

  4. [4]
    4. Binhammer P, Born T.
    Coronal fracture of the body of the trapezium: a case report.
    J Hand Surg [Am] 1998 Jan;23(1):156-7.    .

  5. [5]
    5. Duteille F, Aubrion JL, Dautel G, Merle M.
    Comminutive fracture of the trapezium treated by ligamentotaxis. A case report.
    Rev Chir Orthop Reparatrice Appar Mot. 2001 Apr;87(2):173-5.    .

Citation

Parlorio E (2003, Dec 30).
Comminuted fracture of the trapezium, {Online}.
URL: http://www.eurorad.org/case.php?id=2264
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  • Figure 1
    Severely comminuted fracture of the trapezium
    a b  

    PA view. Multiple bone fragments with involvement of the scaphotrapezial and first carpometacarpal joints.

    Oblique semipronated view. Similar findings. The involvement of the carpometacarpal joint of the thumb is most evident.

     
Figure 1

Severely comminuted fracture of the trapezium

Figure 1a
PA view. Multiple bone fragments with involvement of the scaphotrapezial and first carpometacarpal joints.
 
Figure 1b
Oblique semipronated view. Similar findings. The involvement of the carpometacarpal joint of the thumb is most evident.
 
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