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Trapezial Fractures and Associated fractures of the Ulnar Carpus: A Ring-Bone Model of Injury
Frances Sharpe, MD1; Amber R. Leis, MD2
1Southern California Permanente Medical Group, Fontana, CA, 2Orthopaedic Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA
Hypothesis: Fractures of the trapezium are rare, however the incidence may be under-reported in the literature. Ulnar sided carpal fractures may occur more frequently than reported.
Methods: Over a 5-year period (2004-2009) our electronic records were queried to identify any surgical procedure or hospital encounter with diagnosis codes for wrist fracture, hand fracture, or carpal fracture. Records were reviewed and data were collected regarding which carpal bones were fractured. All cases of trapezium fracture were evaluated further and their cases are presented.
Results: Eight trapezial fractures were identified, representing 8% of all carpal fractures and 26% of all non-scaphoid carpal fractures. Of the 8 trapezium fractures identified, 5 (62.5%) were associated with Bennett’s fracture and 4 (50%) were associated with ulnar sided carpal fractures. Three of these associated ulnar carpal injuries were triquetral fractures including 2 triquetral body fracture and one dorsal chip fracture. The other was a hamate body fracture. All patients were male, age range 17-33, and involved in motorcycle or bicycle accidents. Three of the four cases involved the dominant hand.
Summary: Although trapezium fractures are uncommon injuries, the 1stcarpometacarpal joint is an integral component of the radial column of the hand, making recognition and treatment of these injuries important to maintaining mobility and function of the thumb. Our study demonstrates a higher incidence of these injuries than reported in the literature, likely due to increased recognition of trapezium fractures through advanced imaging or perhaps an increased incidence of injury related to recreational activities. Previously un-reported concomitant ulnar sided carpal body fractures are reported at a frequency nearly equal to that of concomitant Bennett’s fractures in our series. We propose a mechanism of injury where the carpal canal and overlying transverse carpal ligament function as a ring-bone construct similar to the pelvis. Loading of this ring, usually through a direct blow to the transverse carpal ligament produces disruption of the ring in two locations. When a trapezium fracture identified, we recommend further evaluation for ulnar sided injuries of the carpus.
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