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Occult isolated fracture of the trapezoid diagnosed by ultrasonography

  • Daniel L. Ault
  • Aimee R. Jokerst
  • Norman W. Kettner
Case Report
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Abstract

Purpose

To describe a patient with an occult isolated trapezoid fracture of the wrist. Isolated trapezoid fractures are very difficult to detect without advanced radiological imaging, since the fragment displacement does not occur in the sagittal plane. A discussion regarding the investigation of trapezoid fractures utilizing multiple imaging modalities includes the first demonstration of its detection via ultrasonography (US).

Methods

A 26-year-old male presented to a chiropractic teaching clinic with pain involving the left wrist, after vaulting over the handlebars of his bicycle 2 days prior. The mechanism of injury was hyperflexion of the left wrist. Left wrist pain, reduced range of motion, and dorsal soft tissue edematous changes were identified at examination. Although the initial radiographic examination was negative, elevated clinical suspicion triggered an US examination 4 days later. The US exam demonstrated an isolated 1.8 mm dorsal trapezoid fracture, which was minimally displaced by 0.7 mm.

Results

Following the US diagnosis of an isolated trapezoid fracture, the wrist was immobilized. The patient elected to not pursue an orthopedic consultation. Conservative care included ice and Class IV therapeutic laser therapy. The patient reported complete alleviation of clinical symptoms after approximately 2 weeks of splinting and treatment.

Conclusion

We emphasize the limitations of radiography in the diagnosis of this fracture. To our knowledge, this is the first case to describe the use of US in the diagnosis of an isolated trapezoid fracture.

Keywords

Trapezoid Isolated fracture Occult Carpus Ultrasonography 

Sommario

Obiettivo

Descrivere un paziente con una frattura isolata occulta del trapezoide del polso. Le fratture isolate occulte del trapezoide del polso sono difficilmente individuabili in assenza di tecniche avanzate di imaging radiologico poiché il dislocamento del frammento osseo non avviene sul Piano sagittale. Discussione sull’iter diagnostico di frattura del trapezoide usando multiple modalità di imaging, inclusa la prima dimostrazione di identificazione ecografica.

Metodi

Uomo di 26 anni si presenta ad una clinica didattica chiropratica con dolore al polso sinistro dopo una caduta in bicicletta due giorni prima. Il meccanismo del danno è stato l’iperflessione del polso sinistro. All’ingresso sono stati riscontrati dolore al polso sinistro, ridotta escursione del movimento, ed edema dei tessuti molli dorsali. Nonostante la radiografia iniziale fosse negativa, il sospetto clinico ha indotto ad effettuare un’ecografia 4 giorni dopo. L’ecografia rivelò una frattura isolata dorsale del trapezoide di 1,8 mm, con minimo spostamento del frammento di 0,7 mm.

Risultati

A seguito della diagnosi ecografica della frattura isolata di trapezoide, il polso è stato immobilizzato. Il paziente scelse di non chiedere una consulenza ortopedica. La terapia conservativa è stata a base di ghiaccio e laser terapia di classe 4. Il paziente riferì remissione dei sintomi clinici dopo circa 2 settimane di immobilizzazione e terapia.

Conclusioni

Vogliamo sottolineare i limiti della radiografia nella diagnosi di questa frattura. A nostra conoscenza, questo è il primo caso che descrive l’uso dell’ecografia nella diagnosi della frattura isolata di trapezoide. 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

If human beings have participated in the research (**), all procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. If human beings have NOT participated in the research, this article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB) 2018

Authors and Affiliations

  • Daniel L. Ault
    • 1
  • Aimee R. Jokerst
    • 2
  • Norman W. Kettner
    • 1
  1. 1.Department of RadiologyLogan UniversityChesterfieldUSA
  2. 2.Chiropractic Health CentersLogan UniversityChesterfieldUSA

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