From the Guidelines
Surgery is the usual treatment for a trapezium fracture, but simple immobilization is appropriate when fracture fragments are small, nonarticular, or minimally displaced. When considering treatment options for a trapezium fracture, it is essential to prioritize morbidity, mortality, and quality of life as the outcome. According to the American College of Foot and Ankle Surgeons 1, the diagnosis of a trapezium fracture is based on a history of trauma and focal pain on palpation, confirmed with radiographic studies.
Treatment Options
- Immobilization is suitable for small, nonarticular, or minimally displaced fractures
- Surgery is the usual treatment for more complex fractures
- The goal of treatment is to promote proper healing, reduce pain, and restore function to the affected area.
Key Considerations
- Fracture severity and displacement play a crucial role in determining the treatment approach
- A thorough evaluation of the fracture is necessary to determine the best course of treatment
- Regular follow-up appointments with X-rays are important to monitor healing progress, as improper treatment can lead to chronic pain, weakness, and thumb arthritis, ultimately affecting the patient's quality of life.
From the Research
Treatment Options for Trapezium Fracture
- Open Reduction and Internal Fixation (ORIF) is a common treatment option for isolated comminuted trapezium fractures, as seen in the study by 2
- Arthroscopy can be used to treat trapezium fractures, providing direct visualization and accurate restoration of articular congruity, as reported by 3
- Conservative treatment with immobilization in plaster or continuous traction after reduction can be used for non-displaced or stable fractures, as mentioned in the study by 4
- Surgical treatment with open reduction and internal fixation is recommended for fractures with articular displacement or carpometacarpal subluxation, as advocated by 5
- Percutaneous fixation under gravitational traction is a novel method that can be used to treat trapezium fractures, as reported by 6
Key Considerations for Treatment
- Restoring scaphotrapezial and trapeziometacarpal joint congruency is crucial to save the 1st digit range of motion, as highlighted by 2
- Proper treatment of trapezium fractures is essential to prevent post-traumatic arthritis and ensure optimal functional outcomes, as emphasized by 4 and 6
- High-energy trauma can result in more complex fractures, requiring careful evaluation and treatment, as seen in the study by 5
Surgical Techniques
- Open reduction and internal fixation can be performed using various techniques, including the use of K-wires, bone clamps, and headless screws, as described by 2, 3, and 6
- Arthroscopic fixation can be used to treat trapezium fractures, providing a minimally invasive approach, as reported by 3
- Percutaneous fixation under gravitational traction can be used to treat trapezium fractures, allowing for anatomical fixation and minimizing post-traumatic arthritis, as reported by 6