- Kevin deWeber, MD, FAAFP, FACSM
Kevin deWeber, MD, FAAFP, FACSM
- Family Medicine of SW Washington Residency
- PeaceHealth SW Medical Center
- Affiliate Associate Professor of Family Medicine
- Oregon Health and Science University
- Clinical Instructor of Family Medicine
- University of Washington School of Medicine
This topic reviews issues related to fractures of the trapezium. General overviews of wrist pain and carpal fractures, as well as topics devoted to other specific carpal fractures in adults, are presented separately. (See "Evaluation of the adult with acute wrist pain" and "Evaluation of the adult with subacute or chronic wrist pain" and "Overview of carpal fractures" and "Scaphoid fractures" and "Lunate fractures" and "Capitate fractures" and "Trapezoid fractures".)
Hand fractures are among the most common of the extremity injuries, accounting for about 18 percent of all fractures. Carpal bones fractures comprise between 8 and 19 percent of hand fractures . Fractures to bones of the distal carpal row—comprising the trapezium, trapezoid, capitate, and hamate— are less frequent than fractures of bones in the proximal row (scaphoid, lunate, triquetrum, and pisiform).
The trapezium is rarely injured, representing about 4 percent of all carpal fractures [1-6]. When present, trapezium fractures often occur in association with other injuries, most commonly fracture of the first (thumb) metacarpal followed by other carpal bone injuries and the distal radius . (See 'Differential diagnosis' below.)
The trapezium is on the radial side of the distal carpal row, and articulates distally with the thumb metacarpal and proximally with the scaphoid and trapezoid (image 1 and figure 1 and figure 2 and figure 3). The trapezium forms a double saddle articulation with the base of the thumb metacarpal, giving the thumb its unique multi-planar range of motion at this first carpometacarpal (CMC) joint. The trapezium has a slightly concave articulation with the scaphoid, and a flat facet articulation with the trapezoid. A longitudinal ridge is present on the volar surface, which serves as the attachment site for the transverse carpal ligament (or flexor retinaculum). The trapezium forms part of the radial aspect of the carpal tunnel, along with the scaphoid. A detailed discussion of wrist anatomy is provided separately. (See "Anatomy and basic biomechanics of the wrist" and "Finger and thumb anatomy".)
The trapezium is palpable at the base of the thumb on the dorsal side, just proximal to the base of the first metacarpal (picture 1 and picture 2). Having the patient repeatedly abduct and adduct the thumb makes palpation of the first CMC joint and the trapezium easier. The two tendons of the first dorsal extensor compartment (abductor pollicis longus and extensor pollicis brevis) pass directly over the bone. Having the patient abduct and extend the thumb puts these tendons under tension and can help distinguish them from the underlying trapezium. The trapezium is also palpable on the palmar side at the base of the thenar eminence just distal to the scaphoid tubercle.
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- CLINICAL ANATOMY
- MECHANISM OF INJURY
- SYMPTOMS AND EXAMINATION FINDINGS
- RADIOGRAPHIC FINDINGS
- DIFFERENTIAL DIAGNOSIS
- Fracture of scaphoid or other carpal bones
- Distal radius fracture
- First metacarpal fractures and fracture-dislocations
- First CMC dislocation
- First CMC osteoarthritis
- de Quervain (radial styloid) tendinopathy
- INDICATIONS FOR SURGICAL REFERRAL
- INITIAL TREATMENT
- FOLLOW-UP CARE
- RECOMMENDATIONS FOR RETURN TO SPORT OR WORK
- SUMMARY AND RECOMMENDATIONS