Standard ap, lateral, and oblique radiographs should be obtained initially to visualize the osseous structures of the wrist. In this post, we summarize some of the most commonly deployed splints in the ed. On physical exam, they can have wrist swelling and decreased range of motion of the wrist because of pain. To avoid missing this diagnosis, a high index of suspicion and a thorough history and physical examination are nec. Trapezoid fractures usually occur in association with other injuries, most commonly fracture of the hamate, capitate, trapezium, or metacarpals. Displaced fractures of the trapezoid with associated dislocation of the trapezoid itself or the index metacarpal have also been reported. Patients with trapezoid fractures complain of pain at the base of the second metacarpal. The side of the bone that is closest to the back of the. Treatment depends on the degree of displacement and other associated injuries and ranges from activity modification or immo bilization to open.
It is likely that an isolated trapezoid fracture will be missed on plain films, especially. Discuss important neurovascular considerations blood supply etc. Isolated trapezoid fractures have been rarely reported in the literature and are occult on routine radiography. A trapezoid fracture may be difficult to visualize on routine radiograph imaging.
Traumatic volar dislocation of the trapezoid with acute. There is a wide spectrum of carpal injuries, from minor to complex. After conservative treatment by cast immobilization, the complete function. Many carpal injuries are benign needing little or no immobilisation.
Coronal view computed tomography of wrist demonstrating trapezoid fracture. Nagumo a, toh s, tsubo k, ishibashi y, sasaki t 2002 an occult fracture of the trapezoid bone. There are two types of fracture of the ridge of the trapezium. Direct trauma to the metacarpal base, rather than axial compression, can also produce a trapezoid fracture. Traumatic lesions of trapezoid bone are rare because of its wellprotected position in the wrist and hence missed in the past. Introduction summary about significance of fracture including epidemiology. Trapezoid fractures usually occur at the dorsal rim or body.
The low incidence of isolated trapezoid fractures stems from the relatively protected position of the trapezoid bone within the carpus, with both osseous and strong ligamentous figure 1 plain radiographs of the injured wrist. Trapezoid fractures are very uncommon, accounting for less than 1% of all wrist fractures. The trapezoid is the least commonly fractured carpal bone, comprising 4% of all carpal fractures. Scaphoid fracture is a common injury encountered in family medicine. The structure of the trapezoid bone forms a firm, stationary joint with the second metacarpal base. Isolated fracture of the trapezoid bone is due to axial loading on the. Trapezoidal condylar plate report of 15 cases in the. Because it is an infrequently fractured carpal bone, there is a wide variety of treatment plans, including rest, immobilization, and surgery green. Like the capitate, the trapezoid has a protected position and is the least commonly fractured carpal bone. They may also complain of pain in the region of the snuffbox. General overviews of wrist pain and carpal fractures, as well as topics devoted to other specific carpal fractures in adults, are presented separately.
Palmar dislocation of the trapezoid is distinctly more unusual, with 10 reported cases. Because of the high rate of nonunion, neer 4 and others 2,3,6,2345 have advocated primary surgical management of distal clavicle fracture. Pdf a rare isolated trapezoid fracture researchgate. Because the trapezoid is fastened to the trapezium, capitate, and scaphoid by strong ligaments, fracture or dislocation is limited by this rigid fixation. To date, few articles have been published on isolated trapezoid fractures. Magnetic resonance imaging or bone scintigraphy may be useful if the diagnosis remains unclear after. Fractures of the carpus most commonly involve the scaphoid. Because the injury is a hallmark of avulsion of the important dorsal wrist ligaments, cast immobilization of the wrist for 3 to 4 weeks is rec ommended to facilitate ligament healing, followed by progressive return to range of motion and strength ening of the wrist.
Introduction the incidence of condylar fractures among the various mandibular fractures ranges from 17. Treatment approaches have varied from cast immobilization to open reduction and internal fixation, depending on degree of displacement and integrity of the. The scaphoid fractures present some of the greatest dilemmas in management of hand fractures. Since that time there have been 25 reported cases in the literature. The trapezoid is the carpal bone least often fractured, comprising approximately 2 percent of all carpal fractures.
A rare case of isolated trapezium fracture in motorcycle polytrauma. Approach to isolated trapezoid fractures ochsner journal. As with all phalangeal fractures, alignment is key in fracture management is to prevent rotational malalignment tips. Most frequent management and treatment of trapezial fractures can be carried from nonoperative techniques7, 9 thumb immobilisation in a. Diagnosis and management of scaphoid fractures american.
Of all of the fractures of the carpus, the most common is the scaphoid, which represents 68. The splinter series is back with its fourth installment. Surgical management of distal clavicle fractures is indicated for open fractures, skin compromise, and associated vascular injury requiring surgery. Report of 15 cases in the management of mandibular subcondylar fracture. Fractures of the carpal bones involve only a single bone or complex bones with or without ligament rupture. Following the us diagnosis of an isolated trapezoid fracture, the wrist was. Standard pa a, oblique b, and lateral c views demonstrate no obvious bone fracture or dislocation. Mechanisms of injury have typically been reported as an axial load, with or without forced wrist flexionextension, that is transmitted from the second metacarpal indirectly to the trapezoid. However, fractures of the trapezoid are rarely seen.
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