Operative Treatment of an Isolated, Comminuted, Biarticular Trapezium Fracture: A Case Report and Review of the Literature.

Background: Isolated, highly comminuted trapezium fractures are extremely rare. While they can be initially diagnosed with plain radiographs, a computed tomography scan of the wrist will more clearly reveal the fracture details and aid in appropriate preoperative planning. Restoration of the fracture with a congruent reduction of the adjacent joints is mandatory for a favorable prognosis. Case Description: A case of a highly comminuted, biarticular, trapezium fracture in a young male patient that was treated operatively with open reduction and internal fixation (ORIF) with a cannulated miniscrew and an additional Kirschner wire (K-wire) is presented. Restoration of a decent intra-articular congruity of the trapezium with both the base of the first metacarpal distally and the scaphoid bone proximally ensured a favorable outcome. Literature Review: Various operative techniques are presented in current literature, encompassing ORIF with screws and K-wires, closed reduction and percutaneous fixation with K-wires, mini-external fixation, button fixation, and arthroscopically assisted percutaneous fixation. A favorable prognosis is documented in cases where a congruous reduction of the fracture was achieved and maintained throughout the healing period. Clinical Relevance: We feel that a formal ORIF is the procedure of choice for highly comminuted trapezium fractures, as they are not easily amenable to accurate reduction by means of closed methods.