Subscribe to RSS
Dorsal Dislocation of the Trapezoid with Metacarpal Instability: A Boxing Injury
Background The second and third metacarpals are firmly attached, immobile structures which for the stable pillar of the hand. The trapezoid has been described as the keystone of the wrist, allowing a wide range of functional motion as well as inherent anatomic and biomechanical stability to the carpus.
Case Description We describe a novel boxing injury with a 180-degree in situ dislocation of the right trapezoid with concomitant second and third carpometacarpal (CMC) joint dislocations. Open anatomic reduction of the trapezoid was obtained, and subsequent percutaneous pinning of the metacarpals allowed for a full functional recovery and return to sports at 6 months.
Literature Review Combined trapezoid and CMC dislocations are extremely rare and have only been previously described in high-energy mechanism injuries, involving a direct dorsal force such as from the steering wheel in a motor vehicle collision. There are no previous reports of this injury occurring in the setting of direct axial load along the metacarpals in a clenched fist such as in a punch or fighting injury.
Clinical Relevance The rare nature of this combined injury, its novel mechanism, and the difficulty in interpreting acute injury and postreduction radiographs require that the treating physician have a high degree of clinical suspicion for associated injuries when CMC dislocations are identified. Treatment strategies incorporating intraoperative fluoroscopy, open anatomic reduction of the trapezoid under direct visualization along with closed reduction, and pinning of the metacarpals reestablish carpal stability and provide excellent long-term results.
Received: 18 March 2020
Accepted: 06 July 2020
Article published online:
27 August 2020
© 2020. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
- 1 Lahiji F, Zandi R, Maleki A. First carpometacarpal joint dislocation and review of literatures. Arch Bone Jt Surg 2015; 3 (04) 300-303
- 2 Broadbent MR, Bach OS, Johnstone AJ. In situ rotational dislocation of the trapezoid associated with carpal-metacarpal dislocations. Hand Surg 2009; 14 (01) 31-33
- 3 Keith J, Wollstein R. Combined dislocation of the trapezoid and finger carpometacarpal joints-the steering wheel injury: case report. J Hand Surg Am 2010; 35 (09) 1454-1456
- 4 Laing AJ, Tansey C, O'Sullivan MJ. Trapezoid and scaphotrapezial dislocation. J Trauma 2004; 56 (03) 713-715
- 5 De Smet L, Rosseel H. Dorsal dislocation of the trapezoid. Eur J Emerg Med 2003; 10 (02) 143-145
- 6 Dunkerton M, Singer M. Dislocation of the index metacarpal and trapezoid bones. J Hand Surg Br 1985; 10 (03) 377-378
- 7 Ostrowski DM, Miller ME, Gould JS. Dorsal dislocation of the trapezoid. J Hand Surg Am 1990; 15 (06) 874-878
- 8 Wright A, Umaar R. Dorsal dislocation of the trapezoid with carpo-metacarpal dislocations: a case report and a description of the “missing carpal sign” on radiographs. J Emerg Med 2014; 47 (04) e95-e97
- 9 Koenig TR, West OC. Palmar dislocation of the trapezoid. Skeletal Radiol 2003; 32 (02) 95-98