J Bone Joint Surg [Am] 72: 446–448 . 36-40. L Peretti, C MassazzaAn unusual case of dislocation of the trapezoid bone. The anatomy of each bone will be examined here, and then the basic anatomy of the STT joint will be described to help the reader understand the genesis of STT arthritis. Axial fractures and dislocations can be complicated by associated neurovascular, muscular, and/or tendinous injury. Below is a systematic approach to interpretation. Because of its well-protected position in the wrist, traumatic lesions of the trapezoid bone are rare. The trapezoid bone is one of eight carpal bones that forms part of the wrist joint. Trapezium Bone Anatomy and Structure Surfaces and Articulation. The patient was placed in a sugar-tong splint and given orthopedic follow up. Displacement of any of these bones may result in Wrist Dislocation. The proximal surface of the trapezium, in combination with the surface of the trapezoid, forms a slightly concave facet for articulating with the distal surface of the scaphoid [11]. The scaphoid bone is joined with both rows of carpal bones. The structure of the trapezoid bone forms a firm, stationary joint with the second metacarpal base. We report an unusual variant of a palmar trapezoid dislocation with a shearing fracture of the dorsal cortex treated with mini-fragment screw fixation. Distally from the scaphoid is the trapezium. Google Scholar 10. fracture or dislocation. The condition may also be accompanied by ligament and nerve damage. Computed tomography obtained due to concern for an occult fracture revealed a comminuted fracture of the trapezoid bone involving the articular surface with an anteriorly displaced bone fragment (Figures 1 and 2). Triquetrum fractures are the second least common fractures among carpal bones. This wrist bone resembles a medium cashew in size and shape ... the lunate, capitate, trapezoid, and trapezium, along with the lower arm bone radius. The shape and size of this bone and its location below the thumb cause the integrity of the trapezium to deteriorate over time. The bones of wrist and hand collectively form the wrist. The proximal surface has a triangular smooth and convex facet, articulating with the distal end of the radius [3]. The eight carpal bones that form the wrist joint are named as the Capitate, Trapezoid, Hamate, Pisiform, Trapezium, Lunate, Scaphoid and Triquetrum. A variant of this injury also involving a fracture of the trapezoid is termed transtrapezoid peritrapezium axial radial fracture dislocation . This fracture typically occurs due to direct trauma to the hand or wrist. Lunate is the semilunar bone that fits in the distal radius. Dorsal and volar extrinsic liga-ments connect the carpal bones with the radius and ulna whereas the intrinsic liga-ments interconnect carpal bones. Google Scholar. It is conservatively treated without dislocation. We report a rare variant with no concomitant injury to the metacarpals or carpal bones. Additionally, a small avulsion fracture at the scribed in the world literature. This row is closely approximated to the metacarpal bones. We report a new combination of these injuries where fracture-dislocation of the base of the 1st metacarpal bone occurred simultaneously with a comminuted fracture of the trapezium, dislocation of the trapezoid and metacarpal joints (2nd to 5th) and an avulsion fracture of the hamate. The square bone that bridges the proximal and distal half of the wrist is the pisiform. Two weeks after injury, he presented at our hospital with mild swelling on the dorsal radius of the right wrist and tenderness at the snuff box. [1] It is a wedge-shaped carpal bone that resembles the trapezium. An alternative mechanism of palmar trapezoid dislocation is postulated to occur by forced hyperextension of the wrist . If there is sustained pain in the wrist and hand after punching, combined trapezoid and scaphoid fractures should be considered as the possible injury. The carpal bones are scaphoid, pisiform, trapezium, lunate, trapezoid, capitate, triquetrum, and hamate. Due to the inherent tight structure of the carpals the circulation can quickly become impaired and lead to avascular necrosis The angular shaped bone visible dorsally is the triquetrum. 89-92 . Google Scholar 11. J Hand Surg 1983;8:375-82. Background: The trapezoid is the least commonly fractured carpal bone, comprising 4% of all carpal fractures. J Hand Surg, 5 (1980), pp. Rhoades CE, Reckling FW (1983) Palmar dislocation of the trapezoid. The trapezoid is shaped like a wedge. The trapezium also touches two other bones in the wrist joint, the scaphoid and trapezoid bones. A review of the literature regarding trapezium and trapezoid dislocations as well as the treatment of these injuries is presented. 602-604. Google Scholar 9. There were also mild radial subluxations of the third and fourth metacarpals. 5. Dislocation of the either the trapezium or the trapezoid are both rare injuries, even among carpal dislocations. We present the case of a 50-year-old worker, who sustained a crush injury of his left hand with a dorsal fracture dislocation of the trapezoid bone and the associated second metacarpal bone at the STT, and a concomitant compartment syndrome of the hand. Advertisement . Dislocation of the trapezoid has been reported in 30 patients; fractures are seen even less frequently and usually go with dorsal displacement. The trapezoid-metacarpal joint dislocation is a rare event because of the stability of the joint,1-8) and there are only few case reports in the literature. [2] It is also called the lesser multangular bone. The carpus is held together by firm ligaments which envelope the carpal bones and protect it from damage. Mechanisms of injury have typically been reported as an axial load, with or without forced wrist flexion/extension, that is transmitted from the second metacarpal indirectly to the trapezoid. Isolated fractures are rarely seen and usually related to the high energy trauma. Meyn MA Jr, Roth AM (1980) Isolated dislocation of the trapezoid bone. The anatomy of the scaphoid, trapezium, and trapezoid and the articulations between these three carpal bones are unique and help explain why these three bones are often involved in arthritis of the wrist. J Hand Surg1980;5:874-8. Arthrodesis is recommended over excision because the latter may lead to metacarpal migration and subsequent carpal arthritis. A trapezoid fracture is a break in the trapezoid bone of the wrist. J Hand Surg 8: 85–88. Axial dislocation and fracture dislocation. trapezoid bone and the strong ligament attachments with adjacent bones. Case Report. The trapezium is located most radially. The wrist series examines the carpal bones (scaphoid, lunate, triquetrum, pisiform, trapezium, trapezoid, capitate and hamate), the radiocarpal joint and the distal radius and ulna. The side of the bone … MA Meyn, AM RothIsolated dislocation of the trapezoid bone. The word trapezoid is derived from the Greek word trapezion which means “a little table” of “irregular quadrilateral”. Bull Hosp Jt Dis Orthop Inst, 4 (1943), pp. 11. ... Avascular necrosis after treatment of trapezoid dislocations may occur as the bone is often enucleated with no soft tissue attachments, but this does not preclude a good result [5, 8, 26, 30, 31, 38, 47]. Looking through that, one can see the convexity of the scaphoid. To date, few articles have been published on isolated trapezoid fractures. The second Dislocation of the trapezoid is a very uncommon injury. The lunate acts as a central anchor for the carpal bones. PMID: 18984327 [Indexed for MEDLINE] Publication Types: Case Reports; MeSH … Because of its well-protected position in the wrist, traumatic lesions of the trapezoid bone are rare. H MilchIsolated luxation of the lesser multangular. The scaphoid links the two rows of carpals. Trapezoid bone fracture is the least common fracture owing to the fact that it is strictly bounded to scaphoid, capitate and the base of the second metacarpal. Dislocation of the either the trapezium or the trapezoid are both rare injuries, even among carpal dislocations. It is associated with other bony or ligamentous injuries in the wrist. The authors report two cases of isolated, undisplaced, fractures of the trapezoid bone. We report a case of combined volar trapezium dislocation and dorsal trapezoid dislocation with other concomitant injuries. Stein AH. Fall on an outstretched hand; Sports injuries; Vehicular accidents ; Physical combat; Direct hit … Isolated fractures of the trapezoid bone have been rarely reported in the literature, the mechanism of injury being an axial or bending load transmitted through the second metacarpal. We herein report a case of a trapezoid frac-ture and dorsal dislocation of the lunate. Google Scholar. Bones can sustain stress fractures (thin hairline breaks), or complete avulsion or dislocation. Causes. 9. We report a case of an isolated, nondisplaced trapezoid fracture that was sustained by direct trauma and subsequently treated successfully in a short-arm cast. Clinical Relevance Dorsal dislocation of the trapezoid with its associated second metacarpal is a rare, high-energy injury that can often be missed on plain radiography. Isolated fractures of the capitate are infrequent, representing 2% of carpal fractures. Wrist views are requested when injury to the distal radius/ulna or carpal bones are suspected. Anatomy . Palmar dislocation of the trapezoid is a rare injury, which results from substantial trauma to the wrist. Dorsal dislocation of the lesser multan-gular. The trapezium bone is a small oblong bone which plays a role in the stability of the carpal tunnel as well as the stability of the thumb joint. 10. Gelberman RH, Panagis JS, Taleisnik J, Baumgaertner M. The arterial anatomy of the car-pus: part II – the intraosseous vascularity. It is the smallest bone in the distal row of carpal bones that give structure to the palm of the hand. This patient's treatment is compared to the few previously published reports of palmarly dislocated trapezoids to assist hand surgeons facing this uncommon injury. Google Scholar. We report a case of combined volar trapezium dislocation and dorsal trapezoid dislocation with other concomitant injuries. Scaphoid Bone Articular Surface Anatomy. The trapezium articulates with two of the carpal bones, the scaphoid, and the trapezoid as well as with the first metacarpal bone [7].. The distal row consists of the hamate, capitate, trapezoid and trapezium. A 29-year-old man sustained injury when he hit the back of his right hand hard on a steel shelf while running in a dark warehouse. A trapezoid is constrained and received external force without being dispersed, so it is possible that the axial load to the second metacarpal bone by punching was transmitted to the scaphoid via the trapezoid, leading to the fractures. The lunate bone is central join of carpal bones. The trapezoid bone (lesser multangular bone) is a carpal bone in tetrapods, including humans. J Hand Surg 5: 602–604. Each carpal bone presents with a different complexity of problems should it become fractured and these are often related to interruption to their blood supply. metacarpal bone was dorsally subluxed and had migrated proxi- Thirty-three cases of this injury have been previously de- mally. J Bone Joint Surg AM1971;19:576-83. Chir Organi Mov (Bologna), 65 (1979), pp. Isolated dislocation of the trapezoid bone. 6. Late presentation of trapezoid dislocation may include avascular necrosis. 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