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Trapezium Fractures: The Hidden Wrist Injury You Might Be Missing
Published: Apr 02, 2024
Trapezium fractures are often overlooked wrist injuries that can have serious consequences if left untreated. Understanding the signs and proper diagnosis is crucial for preventing long-term complications.
Spotting the Signs: How to Recognize a Trapezium Fracture
Patients with trapezium fractures typically experience focal tenderness over the trapezium bone at the base of the thumb. Pain and weakness when pinching or making an 'OK' sign are common. Swelling may be minimal, but ecchymosis (bruising) can occur. Snuffbox tenderness may also be present, similar to a scaphoid fracture.
Diagnosis: Why X-rays Aren't Enough
Standard wrist X-rays often miss trapezium fractures due to overlapping shadows from other bones. Special views like the Bett view or carpal tunnel view can help, but CT or MRI scans are often necessary for a definitive diagnosis. Cone beam CT is a promising new option that provides high-resolution images with less radiation exposure.
Treatment: When to Splint and When to Refer
Nondisplaced trapezium fractures can often be treated with 4-6 weeks of immobilization in a thumb spica cast. However, fractures that are displaced more than 2mm, comminuted, or associated with other injuries should be referred to a hand surgeon. Proper follow-up is crucial to ensure healing and prevent complications.
Long-term Outlook: Potential Complications to Watch For
While many trapezium fractures heal well with proper treatment, complications can occur. These may include arthritis, carpal tunnel syndrome, tendon problems, and loss of pinch strength. Patients should be monitored for signs of these issues, especially if they have persistent pain or weakness after treatment.
Frequently Asked Questions
They represent about 4% of all carpal fractures.
Yes, but it will likely be painful and weak.
Typically 4-6 weeks of immobilization, followed by rehabilitation.
Yes, they can be difficult to see on standard X-rays.
Falls onto an outstretched hand or direct blows to the wrist.
Key Takeaways
Trapezium fractures require a high index of suspicion and often advanced imaging for proper diagnosis and treatment.
References
- van Onselen EB, Karim RB, Hage JJ, Ritt MJ. Prevalence and distribution of hand fractures. J Hand Surg Br 2003; 28:491.
- Gibney B, Smith M, Moughty A, et al. Incorporating Cone-Beam CT Into the Diagnostic Algorithm for Suspected Radiocarpal Fractures: A New Standard of Care? AJR Am J Roentgenol 2019; 213:1117.
- Urch EY, Lee SK. Carpal fractures other than scaphoid. Clin Sports Med 2015; 34:51.
This article has been reviewed for accuracy by one of the licensed medical doctors working for Doctronic. Always discuss health information with your healthcare provider.
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