Abstract
Background
Isolated, highly comminuted trapezium fractures are extremely rare. While they can
be initially diagnosed with plain radiographs, a computed tomography scan of the wrist
will more clearly reveal the fracture details and aid in appropriate preoperative
planning. Restoration of the fracture with a congruent reduction of the adjacent joints
is mandatory for a favorable prognosis.
Case Description
A case of a highly comminuted, biarticular, trapezium fracture in a young male patient
that was treated operatively with open reduction and internal fixation (ORIF) with
a cannulated miniscrew and an additional Kirschner wire (K-wire) is presented. Restoration
of a decent intra-articular congruity of the trapezium with both the base of the first
metacarpal distally and the scaphoid bone proximally ensured a favorable outcome.
Literature Review
Various operative techniques are presented in current literature, encompassing ORIF
with screws and K-wires, closed reduction and percutaneous fixation with K-wires,
mini-external fixation, button fixation, and arthroscopically assisted percutaneous
fixation. A favorable prognosis is documented in cases where a congruous reduction
of the fracture was achieved and maintained throughout the healing period.
Clinical Relevance
We feel that a formal ORIF is the procedure of choice for highly comminuted trapezium
fractures, as they are not easily amenable to accurate reduction by means of closed
methods.
Keywords
trapezium - comminuted - fracture - operative treatment
