Abstract
Background Divergent trapezium-trapezoid fracture dislocation is a rare and complex injury.
The authors present an unusual case of dislocation of the trapezium-trapezoid complex
with scaphoid fracture.
Case Description A 25-year-old man suffered a road traffic accident leading to complex carpal injury
due to axial and rotation forces (steer wheel injury) on the left wrist. X-rays and
computed tomographic (CT) scan were done showing trapezium-trapezoid dissociation
with fracture of distal pole of scaphoid and ulna styloid. The second metacarpal base
was fractured with many ligamentous injuries in the wrist.
Methods Volar flexor carpi radialis (FCR) approach was used to reduce and fix scaphoid fracture
with 2.7-mm cannulated screw. Dorsal approach was used to fix fracture of second metacarpal
base and perform reduction in trapezium-trapezoid complex with help of 0.8-mm K-wires,
and suspension wiring of first to second and second to third metacarpal was done using
1.5-mm K-wires. The transverse flexor retinaculum (TFR) in this case was avulsed.
Discussion The divergent trapezium-trapezoid joint with scaphoid fracture is not described in
the literature yet. The authors implicate steering wheel injury pattern for such complex
carpal fracture dislocations. CT scan is imperative to diagnose and plan treatment
of such fracture morphology. Early fracture reduction and stabilization of carpal
dislocations are essential for proper functioning of wrist.
Keywords
complex carpal injuries - divergent axial-radial-ulnar - steering wheel injury - scaphoid
fracture - divergent trapezium-trapezoid dissociation
