Immobilization of Trapezial Ridge Fractures
For trapezial ridge fractures, a thumb spica splint should be used as the primary immobilization method, as splints are the optimal choice for acute injuries with anticipated swelling and allow for better accommodation of swelling than casts. 1
Diagnosis and Imaging Considerations
- Standard radiographic views (anteroposterior, lateral, and oblique) often miss trapezial ridge fractures 2, 3
- A carpal tunnel view is essential for proper diagnosis of trapezial ridge fractures 2, 3
- Point tenderness over the base of the thenar eminence and pain upon resisting wrist flexion are key clinical findings 3
Immobilization Protocol
Type of Immobilization
- Use a non-circumferential thumb spica splint that immobilizes the wrist and thumb 1
- Splints are preferred over casts as they:
- Better accommodate anticipated swelling
- Allow for skin inspection and hygiene
- Permit assessment of neurovascular status
Duration of Immobilization
- Average immobilization duration should be 3-4 weeks 1
- Clinical and radiographic reassessment at 2-3 weeks to evaluate healing progression 1
- Type I fractures (at the base of the trapezial ridge) typically heal with proper immobilization 3
- Type II fractures (avulsion of the tip of the ridge) may not heal with immobilization alone 3
Rehabilitation Protocol
Early Phase (0-2 weeks)
- Strict immobilization with the splint 1
- Begin active finger motion exercises immediately to prevent stiffness 1
- Weight-bearing as tolerated
Intermediate Phase (2-4 weeks)
- Continue immobilization
- Begin gentle range of motion exercises if healing is progressing appropriately 1
Late Phase (4-6 weeks)
- Transition to normal activities
- Progressive strengthening exercises 1
- Full recovery typically expected within 6-8 weeks 1
Complications to Monitor
- Delayed diagnosis can lead to nonunion, chronic discomfort, and weakness of pinch and grasp 2
- Excessive immobilization risks chronic pain, joint stiffness, and muscle atrophy 1
- Inadequate immobilization can result in delayed healing and malunion 1
Special Considerations
- For diabetic patients: Close monitoring of skin is essential to prevent pressure points and breakdown 1
- For elderly patients: Evaluate for osteoporosis risk factors and consider calcium and vitamin D supplementation 1
- For athletes: Discuss realistic timeline for return to sports activities 1
- Advise smoking cessation as it increases nonunion rates and leads to inferior clinical outcomes 1