Acute wrist injury.
The patient complained of pain at the base of the thumb after a high-energy trauma (traffic accident). Standard radiographs of the wrist demonstrated a comminuted intraarticular fracture of the trapezium bone. Posteroanterior and semipronated oblique views are shown (Fig. 1).
Isolated fractures of the carpal bones, excluding the scaphoid, are relatively uncommon (1). Trapezial fractures have been described in association with fractures of the scaphoid and hamate bones, Bennet's fracture-dislocation and common carpometacarpal joint dislocation; they are felt to be related to shearing forces (2). Isolated fractures are rare (3% of carpal fractures) (3) and can occur after hyperextension of the thumb or a fall on the abducted thumb. Trapezial fractures may involve either the body (4) or the volar ridge of the bone, and are often missed on standard plain radiographs. Comminutive fractures of the trapezium have also been described (5). At most institutions, oblique radiographs are included as part of the standard wrist exam to increase sensitivity to carpal fractures. The standard oblique view (external) is taken in the PA position with the hand in partial pronation. This radiographic projection optimally demonstrates the scaphoid, trapezium, the base of the first metacarpal and the intervening joint spaces. The carpal tunnel view is useful to detect fractures of the volar surface of the trapezium.
Comminuted trapezial fracture
The patient is a 35-year-old male with acute wrist trauma. Based on the provided AP and oblique X-ray images, the following findings are noted:
• Near the radial side of the wrist, around the base of the first metacarpal, there is a discontinuity of the bone cortex with a fine fracture line. This suggests a fracture in the distal portion of the scaphoid or in the trapezium (Trapezium).
• The fracture line is located more toward the anterior-lateral side. Considering the anatomic structure of the trapezium, it likely involves the trapezium body or the volar ridge.
• The surrounding joint space is relatively preserved, and the alignment of the trapezium with adjacent articular surfaces is largely intact, with no obvious dislocation.
• No significant morphological abnormalities are noted in the other carpal bones (e.g., lunate, triquetrum, capitate, etc.).
• Soft tissue swelling is not prominent.
Based on the X-ray findings and the patient's history, the possible diagnoses include:
1. Trapezium (Trapezium) Fracture:
• Clinically less common, but can occur when excessive stress is placed on the thumb due to hyperextension or trauma.
• The X-ray may show a fracture line in the trapezium body or its volar ridge.
• Consistent with the patient's history of trauma (fall on an outstretched thumb or wrist impact).
2. Scaphoid Fracture:
• In ulnar-radial deviation or oblique views, fractures in the distal scaphoid can sometimes be mistaken for a different site.
• This is more common clinically, so careful evaluation is needed.
• High-resolution X-ray or MRI may be necessary to rule it out.
3. Other Carpal Bone Fractures:
• Such as the capitate, hamate, etc. Although less apparent clinically and on imaging, they should still be ruled out cautiously.
Considering the patient’s age, mechanism of injury (possibly involving hyperextension of the thumb or wrist), and the radiographic evidence of cortical disruption in the trapezium, the most likely diagnosis is an isolated trapezium fracture.
1. Treatment Strategy
• Conservative Treatment: If the fracture is relatively stable with no apparent displacement or significant risk of joint surface damage, thumb spica casting or a wrist-based orthosis can be applied for 4–6 weeks. During this period, avoid excessive force and impact to the thumb and wrist.
• Surgical Treatment: In cases of significant displacement, articular surface damage, comminuted fractures, or risk of nonunion, surgical intervention with internal fixation may be required to stabilize the fracture and preserve joint function.
2. Rehabilitation and Exercise Prescription
• Early Immobilization Phase (0–4/6 weeks)
- Use a thumb spica cast or orthosis to limit large-range movements of the wrist and thumb.
- Actively move the shoulder, elbow, and fingers to prevent muscle atrophy and joint stiffness.
- If there is significant pain, anti-inflammatory and analgesic medications can be used under medical advice.
• Mid-Stage Functional Recovery (4/6–8 weeks)
- After removal or reduction of immobilization, gradual range-of-motion exercises can be introduced without causing pain, such as wrist flexion and extension, thumb opposition, and abduction.
- Perform these exercises 2–3 times a day, 5–10 minutes each time, and gradually increase as tolerated.
- Warm compresses or physical therapy can help improve local circulation and reduce inflammation.
• Late Strengthening Phase (after 8 weeks)
- Progress to simple resistance exercises (e.g., squeezing a stress ball, using a resistance band for the wrist) to enhance muscle strength.
- Practice thumb pinch and functional movements (such as picking up small objects, wringing a towel), gradually returning to normal activities.
- Avoid unnecessary high-impact or excessive load on the wrist during daily life and exercises.
• Precautions
- Patients with poor bone quality or comorbid conditions (e.g., diabetes) should be closely monitored for fracture healing.
- Maintain joint mobility to prevent stiffness due to prolonged immobilization.
- All exercises should be performed under the guidance of a professional rehabilitation therapist or physician.
This report is only a reference analysis based on the currently provided medical records and imaging information. It cannot replace an in-person medical consultation or a specialist doctor’s diagnostic and treatment opinion. For any personal health-related decisions, please consult a specialist physician and consider additional examination results for a comprehensive evaluation.
Comminuted trapezial fracture
