- 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
- Section Editors
- Patrice Eiff, MD
Patrice Eiff, MD
- Section Editor — Adult Orthopedics; Sports-Related Injuries
- Professor of Family Medicine
- Oregon Health & Science University
- Chad A Asplund, MD, FACSM, MPH
Chad A Asplund, MD, FACSM, MPH
- Associate Professor of Health and Kinesiology
- Director of Athletic Medicine
- Head Team Physician
- Georgia Southern University
This topic reviews issues related to fractures of the trapezoid. 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 "Hamate fractures" and "Lunate fractures" and "Capitate fractures" and "Pisiform fractures" and "Triquetrum fractures" and "Trapezium fractures".)
Hand fractures are among the most common of the extremity injuries, accounting for approximately 18 percent of all fractures. Carpal bone fractures comprise upwards of 8 percent of hand fractures . Fractures to bones of the distal carpal row, consisting of the trapezium, trapezoid, capitate, and hamate, are less frequent than fractures of bones in the proximal row (scaphoid, lunate, triquetrum, and pisiform).
The trapezoid is the carpal bone least often fractured, comprising approximately 2 percent of all carpal fractures [1-4]. Trapezoid fractures usually occur in association with other injuries, most commonly fracture of the hamate, capitate, trapezium, or metacarpals . (See 'Differential diagnosis' below.)
Anatomy of particular relevance to trapezoid fractures is discussed below. A detailed discussion of wrist anatomy is provided separately. (See "Anatomy and basic biomechanics of the wrist".)
The location and shape of the trapezoid convey relative protection, hence the rarity of isolated injury. The trapezoid lies in the distal carpal row and articulates distally with the second metacarpal base, radially with the trapezium, ulnarly with the capitate, and proximally with the scaphoid (image 1 and figure 1 and figure 2). It is keystone shaped, with a dorsal width twice its palmar width. It forms a stable and relatively immobile articulation with the second metacarpal and has strong ligamentous attachments to adjacent carpal bones.
- van Onselen EB, Karim RB, Hage JJ, Ritt MJ. Prevalence and distribution of hand fractures. J Hand Surg Br 2003; 28:491.
- 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.
- Balci A, Basara I, Çekdemir EY, et al. Wrist fractures: sensitivity of radiography, prevalence, and patterns in MDCT. Emerg Radiol 2015; 22:251.
- Hey HW, Chong AK, Murphy D. Prevalence of carpal fracture in Singapore. J Hand Surg Am 2011; 36:278.
- Kain N, Heras-Palou C. Trapezoid fractures: report of 11 cases. J Hand Surg Am 2012; 37:1159.
- Blomquist GA, Hunt Iii TR, Lopez-Ben RR. Isolated fractures of the trapezoid as a sports injury. Skeletal Radiol 2013; 42:735.
- Ting MH, Tompson JD, Ek ET. Isolated dislocation of the trapezoid. Hand Surg 2012; 17:391.
- Komura S, Yokoi T, Nonomura H, et al. Incidence and characteristics of carpal fractures occurring concurrently with distal radius fractures. J Hand Surg Am 2012; 37:469.
- Sawardeker PJ, Baratz ME. Carpal injuries. In: DeLee's & Drez's Orthopaedic Sports Medicine: Principles and Practice, 4th ed., Miller MD, Thompson SR. (Eds), Elsevier Saunders, Philadelphia 2015. p.861.
- Urch EY, Lee SK. Carpal fractures other than scaphoid. Clin Sports Med 2015; 34:51.
- Suh N, Ek ET, Wolfe SW. Carpal fractures. J Hand Surg Am 2014; 39:785.
- Jeong GK, Kram D, Lester B. Isolated fracture of the trapezoid. Am J Orthop (Belle Mead NJ) 2001; 30:228.
- Cassidy C, Ruby L. Fracture and dislocations of the carpus. In: Skeletal Trauma: Basic Science, Management, and Reconstruction, 5th ed., Browner BD, Jupiter JB, Krettek C, Anderson PA. (Eds), Elsevier Saunders, Philadelphia 2015. p.1217.
- PERTINENT ANATOMY
- MECHANISM OF INJURY
- SYMPTOMS AND EXAMINATION FINDINGS
- RADIOGRAPHIC FINDINGS
- DIFFERENTIAL DIAGNOSIS
- Fracture of the trapezium, capitate, scaphoid, or other carpal bones
- Distal radius fracture
- Fractures and fracture-dislocations of the second metacarpal
- Dislocation of the trapezoid
- INDICATIONS FOR SURGICAL REFERRAL
- INITIAL TREATMENT
- FOLLOW-UP CARE
- RECOMMENDATIONS FOR RETURN TO SPORT OR WORK
- SUMMARY AND RECOMMENDATIONS