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CASE REPORT Table of Contents   
Year : 2007  |  Volume : 41  |  Issue : 2  |  Page : 175-176
Trapezoid fracture caused by assault


Department of Orthopedics and Trauma, King Edward Memorial Hospital, Rasta Peth, Pune, India

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   Abstract 

In this report we describe an open fracture of trapezoid and break in anterior cortex of capitate due to assault in a young adult male. Direct impact force of a sharp object to the first web space caused the above fractures. Open reduction and internal fixation of the trapezoid was carried out using Kirschner wires. Cut extensor tendons, extensor retaniculum, capsule, adductor pollicis muscle, first dorsal interosseous muscle, soft tissue and overlying skin were sutured primarily. Three months after the operation the patient has made a complete recovery. There is no similar case reported in the literature.

Keywords: Assault, fracture trapezoid bone, internal fixation

How to cite this article:
Malshikare V A, Oswal A V. Trapezoid fracture caused by assault. Indian J Orthop 2007;41:175-6

How to cite this URL:
Malshikare V A, Oswal A V. Trapezoid fracture caused by assault. Indian J Orthop [serial online] 2007 [cited 2019 Oct 17];41:175-6. Available from: http://www.ijoonline.com/text.asp?2007/41/2/175/32053

   Introduction Top


Isolated trapezoid fracture is extremely rare. We hereby present a case of trapezoid fracture in view of its rarity.


   Case Report Top


A 22-year-old man was assaulted by a sharp object. While attempting to protect himself he sustained an injury to the right hand. He presented with a sharp clean lacerated wound and swelling on first web space, which was extending around the right thumb from the proximal palmar crease to the distal carpal row dorsally with an open fracture of the trapezoid.

There was near full thickness injury to the adductor pollicis muscle, first dorsal interosseous muscle, capsule of the second carpometacarpal joint and extensor retinaculum. The tendons of extensor carpi radialis brevis (ECRB), extensor indices and extensor digitorum of the second and third fingers were also ruptured. However, there were no neurovascular complications.

Radiological examination showed a displaced oblique fracture of the body of trapezoid [Figure - 1]. The computerized tomography (CT) showed a fracture of trapezoid and break in anterior cortex of capitate [Figure - 2].

On the day of injury, after primary wound care, open reduction and internal fixation of trapezoid with Kirschner wires was carried out [Figure - 3]. All tendons, capsule, retinaculum and adductor pollicis muscle were promptly repaired. Followup CT scan showed a stable fixation of trapezoid. A dorsal plaster of Paris slab with the wrist in extension and slight flexion at carpometacarpal joint was applied for six weeks postoperatively. Six weeks after the operation the Kirschner wires were removed. Active physiotherapy was started at 6 weeks.


   Discussion Top


The trapezoid forms a very stable, relatively immobile joint with the second metacarpal base distally. It is bound by strong ligaments to the trapezium radially, capitate ulnarly and scaphoid proximally. The trapezoid is shaped like a keystone and is widest dorsally. It is the least commonly injured carpal bone, involved in less than one per cent of carpal injuries. [1],[2] There are six reports of the trapezoid fracture in the English literature. [5],[6],[7],[8],[9],[10],[11] However, isolated fracture of the trapezoid is extremely rare and only two cases have been previously reported. [5],[11] The fracture of the trapezoid has not been reported with any other carpal fractures. [9] An axial force applied to the second metacarpal usually produces fractures of the trapezoid. [2],[3],[4] In the present case, fracture appeared to be caused by the impact of a sharp object. Computerized tomography was useful in attaining a definitive diagnosis and evaluation of fractures of the trapezoid. [6] Since little has been written on the treatment of trapezoid fractures, a standard treatment method for trapezoid fractures has not been established. In two cases conservative therapy were chosen [5],[6] and one case required removal of a small fragment of trapezoid. [7] On the other hand, fractures of the trapezoid sometimes require open reduction and internal fixation. [2],[3],[8],[11] In the present case, as displacement was noted and the fracture being open, open reduction and internal fixation was performed. [11]


   Acknowledgement Top


We wish to thank Dr. Sunil Otiv, Mr. Satish Kutty, Dr. Dayanand Shetty, Dr. Khandu Padwal, Dr. Amit Mahajan for their kind help.

 
   References Top

1.Botte MJ, Gelberman RH. Fractures of the carpus, excluding the scaphoid. Hand Clin 1987;3:149-61.   Back to cited text no. 1  [PUBMED]  
2.Cohen MS. Fractures of the carpal bones. Hand Clin 1997;13:587-99.   Back to cited text no. 2  [PUBMED]  
3.Failla JM, Amadio PC. Recognition and treatment of uncommon carpal fractures. Hand Clin 1988;4:469-76.   Back to cited text no. 3  [PUBMED]  
4.Garcia-Elias M, Dobns JM, Cooney WP 3 rd , Linscheid RL. Traumatic axial dislocations of the carpus. J Hand Surg Am 1989;14:446-57.   Back to cited text no. 4    
5.Jeong GK, Kram D, Lester B. Isolated fracture of the trapezoid. Am J Orthop 2001;30:228-30.   Back to cited text no. 5  [PUBMED]  
6.Miyawaki T, Kobayashi M, Matsuura S, Yanagawa H, Imai T, Kurihara K. Trapezoid bone fracture. Ann Plast Surg 2000;44:444-6.  Back to cited text no. 6  [PUBMED]  
7.Nagumo A, Toh S, Tsubo K, Ishibashi Y, Sasaki T. An occult fracture of the trapezoid bone: A case report. J Bone Joint Surg Am 2002;84:1025-7.   Back to cited text no. 7  [PUBMED]  [FULLTEXT]
8.Watanabe H, Hamada Y, Yamamoto Y. A case of old trapezoid fracture. Arch Orthop Trauma Surg 1999;119:356-7.   Back to cited text no. 8  [PUBMED]  [FULLTEXT]
9.William HS Jr, Rick FP. Fractures and dislocations of the wrist. Rockwood CA, Green DP, editors. Fractures in adults. 5 th ed. JP Lippincott: Philadelphia; 2001.  Back to cited text no. 9    
10.Yasuwaki Y, Nagata Y, Yamamoto T, Nakano A, Kikuchi H, Tanaka S. Fracture of the trapezoid bone: A case report. J Hand Surg Am 1994;19:457-9.  Back to cited text no. 10  [PUBMED]  
11.Hitora T, olated trapezoid fracture: A rare case of carpal injury. Injury Extra 2005;36:402-4.  Back to cited text no. 11    

Top
Correspondence Address:
V A Malshikare
Department of Orthopedics and Trauma, King Edward Memorial Hospital, Rasta Peth, Pune - 411 011
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5413.32053

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    Figures

  [Figure - 1], [Figure - 2], [Figure - 3]

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    Abstract
    Introduction
    Case Report
    Discussion
    Acknowledgement
    References
    Article Figures
 

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