Open complete dislocation of trapezium with a vertically split fracture: a case report
© Mumtaz and Drabu; licensee BioMed Central Ltd. 2009
Received: 13 October 2009
Accepted: 26 November 2009
Published: 26 November 2009
Open complete dislocation of the trapezium is an extraordinarily rare injury with only a few cases reported so far in literature. The association of a vertically split fracture makes this injury even rare and hence worth reporting. A 14 year old Kashmiri boy presented to us with a history of massive trauma to the non dominant left hand sustained as a result of a blow from a heavy hammer. The thenar area was burst out and the trapezium was vertically split apart into two halves which were dislocated from the articular surfaces of the scaphoid as well as the first metacarpal. The mechanism of injury as in other such reported cases was a massive direct force localized over the carpal bone which causes its enucleation and fracture. Although some authors have recommended excision of the dislocated trapezium, open reduction of the fracture dislocation and fixation with K wires was carried out under General anesthesia. At the end of one year although there was some functional deficit in the affected thumb, especially in opposition, the patient was quite satisfied with the outcome as this was the non dominant hand.
Fractures of the trapezium account for 3-5% of carpal bone fractures and Less than a fifth of these are sagitally split. Open dislocation of trapezium at first carpometacarpal and scaphotrapezial joints is a very rare injury [2, 3]. After review of literature Peterson  in1950 reported only 10 cases of trapezium dislocation, however only two of these could be considered as complete dislocations. Afterwards a few more of such cases have been described[2, 3]. We report an extraordinarily rare combination of open complete dislocation of Trapezium at first carpometacarpal and scapho trapezial joints associated with a vertically split open book type fracture.
Open dislocation of trapezium at first carpometacarpal and scaphotrapezial joints is a very rare injury[2, 3]. Further an associated fracture of trapezium is an extremely rare injury. After review of literature Peterson in 1950 reported only 10 cases of trapezium dislocation, however only two of these could be considered as complete dislocations. Afterwards Siegel  described a case of compound complete dislocation of trapezium with a communited fracture of the trapezoid. Later Seimon  also described another case of open complete dislocation of trapezium with a fracture of the ridge of trapezium. The ligaments binding trapezium to the first metacarpal and the scaphoid are very Strong . Severe direct trauma is necessary to produce the disruption of these ligaments and hence a complete dislocation [2, 3]. This surely was the case in our patient. A review of other reported cases also reveals a similar mechanism of injury in all cases, a massive direct force localized over the carpal bone which causes its enucleation. Some authors  recommended excision of the dislocated trapezium. In the case of our the patient open reduction and K wire fixation yielded satisfactory results.
Written informed consent for publication of this case report and accompanying images was obtained from the father of the patient as he is a minor.
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