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HOME > J Musculoskelet Trauma > Volume 22(4); 2009 > Article
Original Article
Operative Treatment of Trapezium Fractures
Ho Jung Kang, M.D., Nam Heon Seol, M.D., Man Seung Heo, M.D., Soo-Bong Hahn, M.D.
Journal of the Korean Fracture Society 2009;22(4):276-282.
DOI: https://doi.org/10.12671/jkfs.2009.22.4.276
Published online: October 30, 2009

Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea.

Address reprint requests to: Ho Jung Kang M.D. Department of Orthpedic Surgery, College of Medicine, Yonsei University, 146-92, Dogok-dong, Kangnam-gu, Seoul 135-720, Korea. Tel: 82-2-2019-3412, Fax: 82-2-573-5393, kangho56@yumc.yonsei.ac.kr
• Received: April 7, 2009   • Revised: May 18, 2009   • Accepted: July 14, 2009

Copyright © 2009 The Korean Fracture Society. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Purpose
    Fractures of trapezium are uncommon carpal bone fractures and often unrecognized lesions. We investigated about operative treatment of trapezium fracture.
  • Materials and Methods
    Seven patients with fractures of trapezium were evaluated after surgical treatment with a mean follow up time of 18 months (12 months~3 years). Functional assessment (pain, limitation in activities of daily living, satisfaction), physical examination (range of motion, grip strength), and radiographic evaluation were performed. Traumatic arthritis and carpometacarpal joint subluxation were confirmed by radiograph.
  • Results
    During study period, 122 cases were carpal bone fractures, and seven of 122 cases were fractures of trapezium. All cases were intra-articular fractures of trapezium. 1st carpometacarpal joint dislocation at 4 patients, Bennett's fracture at 1 patient, hamate hook fracture at 1 patient, and base of 4th proximal phalanx fracture at 1 patient were associated with fracture of trapezium. Open reduction and internal fixation were performed at 6 cases and 1st carpometacarpal joint arthrodesis was performed at 1 case because of neglected fracture. One of 6 cases which were performed to open reduction and internal fixation was reoperated to external fixation due to reduction loss. Clinically 6 patients revealed good results. one of 7 patients experienced limitation of thumb opposition.
  • Conclusion
    Based on the good results obtained with surgical intervention, we advocated open reduction and internal fixation for fractures with intraarticular depressed more than 2 mm or combined with Bennett's fracture or carpometacarpal subluxation.
  • Key words: Carpal bone, Trapezium fracture, Open reduction and internal fixation
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Fig. 1
(A, B) Radiograph and CT show communited depressed fracture of trapezium.
(C) Immediate postoperative radiograph shows internal fixation with 2 K wires and 1 mini screw.
(D) Anteroposterior radiograph of postoperative 5 weeks shows reduction loss and carpometacarpal subluxation.
(E) Intraoperative photograph shows open reduction using external fixator.
(F) Immediate postoperative radiograph shows open reduction and pinning and external fixation.
(G) Anteroposterior radiograph of postoperative 21 months shows traumatic arthritis.
jkfs-22-276-g001.jpg
Fig. 2
(A, B) Radiograph shows communited fracture of trapezium and Bennett's fracture.
(C) Immediate postoperative radiograph shows internal fixation with 6 K wires and 1 mini screw.
(D) Anteroposterior radiograph of postoperative 3 months shows good union status.
jkfs-22-276-g002.jpg
Fig. 3
(A) CT shows fracture of trapezium and carpometacarpal joint degenerative arthritis and osteophyte formation.
(B) Immediate postoperative radiograph shows carpometacarpal joint fusion with Acutrak screw.
(C, D) Radiograph and CT show nonunion of carpometacarpal joint fusion.
(E, F) Radiograph of second postoperative 2 months shows good union status.
jkfs-22-276-g003.jpg
Table 1
Patient's data
jkfs-22-276-i001.jpg

M: Male, F: Female, O/R: Open reduction, I/F: Internal fixation, E/F: External fixation, CMC D/L: Carpometacarpal dislocation, Fx: Fracture, +: Positive finding of traumatic arthritis, -: Positive finding of traumatic arthritis.

Table 2
Modified Francis's functional assessment
jkfs-22-276-i002.jpg

Figure & Data

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        Operative Treatment of Trapezium Fractures
        J Korean Fract Soc. 2009;22(4):276-282.   Published online October 31, 2009
        DOI: https://doi.org/10.12671/jkfs.2009.22.4.276
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      Operative Treatment of Trapezium Fractures
      Image Image Image
      Fig. 1 (A, B) Radiograph and CT show communited depressed fracture of trapezium. (C) Immediate postoperative radiograph shows internal fixation with 2 K wires and 1 mini screw. (D) Anteroposterior radiograph of postoperative 5 weeks shows reduction loss and carpometacarpal subluxation. (E) Intraoperative photograph shows open reduction using external fixator. (F) Immediate postoperative radiograph shows open reduction and pinning and external fixation. (G) Anteroposterior radiograph of postoperative 21 months shows traumatic arthritis.
      Fig. 2 (A, B) Radiograph shows communited fracture of trapezium and Bennett's fracture. (C) Immediate postoperative radiograph shows internal fixation with 6 K wires and 1 mini screw. (D) Anteroposterior radiograph of postoperative 3 months shows good union status.
      Fig. 3 (A) CT shows fracture of trapezium and carpometacarpal joint degenerative arthritis and osteophyte formation. (B) Immediate postoperative radiograph shows carpometacarpal joint fusion with Acutrak screw. (C, D) Radiograph and CT show nonunion of carpometacarpal joint fusion. (E, F) Radiograph of second postoperative 2 months shows good union status.

      Fig. 1

      Fig. 2

      Fig. 3

      Operative Treatment of Trapezium Fractures

      Patient's data

      M: Male, F: Female, O/R: Open reduction, I/F: Internal fixation, E/F: External fixation, CMC D/L: Carpometacarpal dislocation, Fx: Fracture, +: Positive finding of traumatic arthritis, -: Positive finding of traumatic arthritis.

      Modified Francis's functional assessment
      Table 1 Patient's data

      M: Male, F: Female, O/R: Open reduction, I/F: Internal fixation, E/F: External fixation, CMC D/L: Carpometacarpal dislocation, Fx: Fracture, +: Positive finding of traumatic arthritis, -: Positive finding of traumatic arthritis.

      Table 2 Modified Francis's functional assessment

      Table 1

      Table 2

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