- Patrice Eiff, MD
Patrice Eiff, MD
- Section Editor — Adult Orthopedics; Sports-Related Injuries
- Professor of Family Medicine
- Oregon Health Sciences University
- Section Editor
- Karl B Fields, MD
Karl B Fields, MD
- Editor-in-Chief — Primary Care Sports Medicine (Adolescents and Adults)
- Section Editor — Biomechanics, Rehabilitation, and Recovery; Sports-Related Injuries; Symptom Assessment and Physical Examination
- Professor of Family Medicine and Sports Medicine
- University of North Carolina at Chapel Hill
Upper extremity injuries, including carpal fractures, are common reasons for visits to primary care offices and emergency departments. Carpal fractures are incurred through both major and minor trauma and clinicians should be familiar with the basic principles involved in diagnosis and management.
This topic reviews fractures of the trapezium in adults. An overview of carpal fractures in adults is presented separately. (See "Overview of carpal fractures".)
Upper extremity fractures are among the most common of the extremity injuries with carpal fractures accounting for 18 percent of hand fractures and 6 percent of all fractures [1,2]. Of these, fractures to bones of the distal carpal row (ie, trapezium, trapezoid, capitate, hamate) are less frequent than fractures of bones in the proximal row (ie, scaphoid, lunate, triquetrum, and pisiform).
Fractures of the trapezium account for 1 to 5 percent of all carpal fractures [2-4]. Trapezium injuries often occur in association with other injuries, such as fracture dislocations of the first metacarpal (Rolando and Bennett injuries), first metacarpophalangeal dislocations, scaphoid fractures, and distal radius fractures. Isolated trapezium fractures are uncommon. (See "First (thumb) metacarpal fractures" and "Metacarpal base fractures" and "Scaphoid fractures" and "Distal radius fractures in adults".)
The trapezium is on the radial side of the distal carpal row, and is the carpus that articulates distally with the thumb metacarpal and proximally with the scaphoid and the trapezoid (image 1 and figure 1 and figure 2). The trapezium forms a saddle articulation with the base of the thumb metacarpal. A longitudinal ridge is present on the volar surface, which serves as attachment for the transverse carpal ligament. A detailed discussion of wrist anatomy is provided separately. (See "Anatomy and basic biomechanics of the wrist".)
- Dobyns JH, Beckenbaugh RD, Bryan RS, et al. Fractures of the hand and wrist. In: Hand Surgery, 3rd, Flynn JE (Ed), Williams & Wilkins, Philadelphia 1982.
- Eiff MP, Hatch RL, Calmbach WL. Carpal fractures. In: Fracture Management for Primary Care, 2nd, Saunders, Philadelphia 2003.
- Geissler WB. Carpal fractures in athletes. Clin Sports Med 2001; 20:167.
- Seitz WH, Papandrea RF. Fractures and dislocations of the wrist. In: Rockwood and Green's Fractures in Adults, 5th, Bucholz RW, Heckman JD (Eds), Lippincott Williams & Wilkins, Philadelphia 2002.
- Walker JL, Greene TL, Lunseth PA. Fractures of the body of the trapezium. J Orthop Trauma 1988; 2:22.
- Giannikas D, Karabasi A, Fotinopoulos E, Tyllianakis M. Open transtrapezial injuries of the thumb: operative treatment. J Trauma 2008; 65:1468.
- Botte MJ, von Schroeder HP, Gellman H, Cohen MS. Fracture of the trapezial ridge. Clin Orthop Relat Res 1992; :202.
- Welling RD, Jacobson JA, Jamadar DA, et al. MDCT and radiography of wrist fractures: radiographic sensitivity and fracture patterns. AJR Am J Roentgenol 2008; 190:10.
- Geissler W, Slade JF. Fractures of the carpal bones. In: Operative Hand Surgery, 6th, Green DP (Ed), Churchill Livingstone, Edinburgh 2011. p.639.