Summary
Introduction
Trapezoidal fractures account for only 0.4% of all carpal bone fractures. Owing to
their rarity, there is paucity in the literature regarding the clinical findings and
treatment. This paper aims to summarize the current understanding of trapezoidal fractures
and present a novel classification algorithm.
Methods
A diagnostic classification algorithm was created based on the known blood supply
and ligamentous attachment of the trapezoid. The proposed treatment algorithm was
then applied to trapezoidal fractures in the literature to validate the algorithm
and determine whether patients received treatment that was in accordance.
Results
A total of 19 articles, representing 22 trapezoidal fractures were included, with
two additional cases presented by the authors. Presenting symptoms were pain (n = 21) and swelling (n = 12). Diagnosis was made on CT in a majority of the time, 79.2% (n = 18). All outcomes were favorable with symptomatic resolution and full range of
motion after treatment, except in four patients that had co-existing wrist injuries.
When the algorithm was applied, 89.5% (n = 17) of the patients received treatment in accordance with the proposed algorithm
and demonstrated good outcomes. In the remaining patients (n = 2) whose treatment differed, one had diminished grip strength and the other was
lost to follow-up.
Conclusions
Given a degree of clinical suspicion including a history of blunt trauma to the hand
and persisting pain, trapezoidal fractures should remain on the differential when
plain radiographs fail to identify any fracture. Operative treatment is suggested
if there is any significant displacement, compromise of the dorsal surface, or breech
of the trapezoidal ligaments causing possible dislocation.
Level of Evidence
IV – Diagnostic.
Keywords
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Article Info
Publication History
Published online: August 25, 2020
Accepted:
August 1,
2020
Received:
August 13,
2019
Identification
Copyright
© 2020 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Corrigendum to “Trapezoidal Fractures: Overview & Introduction of a Novel Diagnostic Classification System” [Journal of Plastic, Reconstructive & Aesthetic Surgery, Vol. 73(11) 2020, 2072–2081]Journal of Plastic, Reconstructive & Aesthetic SurgeryVol. 74Issue 1
