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Trapezium fracture: a common clinical mimic of scaphoid fracture

Emergency Radiology volume 26, pages 531–540 (2019)Cite this article

Abstract

Purpose

Fractures of the trapezium are rarely diagnosed on plain radiographs after acute wrist trauma. High-resolution cross-sectional imaging identifies fractures of the trapezium as the most common radiographically occult carpal bone fracture. We review the fracture frequency, mechanisms and patterns of trapezium fractures.

Methods

Cone beam CT was performed in patients with suspected radiographically occult radiocarpal fracture following acute injury. The frequency of carpal bone fractures was assessed and compared.

Results

Ninety-three radiographically occult wrist fractures were identified in 166 patients with acute trauma and negative radiographs. The trapezium was the most frequently fractured carpal bone, making up 20.4% of wrist fractures. Seventy-nine percent of trapezium fractures involved the volar ridge. The scaphoid was the clinically suspected fractured bone at initial assessment in 84% of patients with trapezium fractures.

Conclusion

Fractures of the trapezium in acute wrist trauma are much more common than described in the literature. If initial radiographs are negative, a fracture of the trapezium is more likely to be present than one of the scaphoid, despite high levels of clinical suspicion for scaphoid injuries. Awareness of the types and mechanisms of trapezium fracture is important. Cross-sectional imaging should be considered in all cases of post-traumatic wrist pain with negative radiographs.

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Author information

Authors and Affiliations

  1. Department of Radiology, Mater Misericordiae University Hospital, Dublin 7, Ireland

    B. Gibney, M. C. Murphy & P. J. MacMahon

  2. Centre for Bioengineering, Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland

    D. P. Ahern

  3. Department of Orthopaedic Surgery, Mater Misericordiae University Hospital, Dublin, Ireland

    D. Hynes

  4. School of Medicine, University College Dublin, Dublin, Ireland

    D. Hynes & P. J. MacMahon

Authors
  1. B. Gibney
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  2. M. C. Murphy
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  3. D. P. Ahern
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  4. D. Hynes
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  5. P. J. MacMahon
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Correspondence to B. Gibney.

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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. This research study received approval by our institution’s ethical review board.

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Gibney, B., Murphy, M.C., Ahern, D.P. et al. Trapezium fracture: a common clinical mimic of scaphoid fracture. Emerg Radiol 26, 531–540 (2019). https://doi.org/10.1007/s10140-019-01702-2

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  • DOI: https://doi.org/10.1007/s10140-019-01702-2

Keywords

  • Trapezium
  • Fracture
  • Trauma
  • Cone beam CT