Trapezium fracture

Background

• Occurs via direct blow to thumb or dorsiflexion and radial deviation force
• Major complication is nonunion

Clinical Features

• Painful thumb movement
• Weak pinch
• TTP at apex of anatomic snuffbox, base of thenar eminence

Differential Diagnosis

Carpal fractures

AP view

• Scaphoid fracture
• Lunate fracture
• Triquetrum fracture
• Pisiform fracture
• Trapezium fracture
• Trapezoid fracture
• Capitate fracture
• Hamate fracture

Evaluation

• Hand x-ray (best seen on 20-degree pronated oblique view)

Trapezium fracture

Management

General Fracture Management

• Acute pain management
• Open fractures require immediate IV antibiotics and urgent surgical washout
• Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention
• Consider risk for compartment syndrome

Immobilization

• Short arm thumb spica splint

Disposition

• Discharge with close hand/ortho follow up

Specialty Care

• Displaced fracture >1mm or diastasis >2mm require surgery

See Also

• Carpal fractures