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TRAPEZIUM FRACTURE

Introduction

Fracture Nomenclature for Trapezium Fracture

Hand Surgery Resource’s Diagnostic Guides describe fractures by the anatomical name of the fractured bone and then characterize the fracture by the Acronym:

In addition, anatomically named fractures are often also identified by specific eponyms or other special features.

For the Trapezium Fracture, the historical and specifically named fractures include:

Trapezium dislocations and fracture-dislocations

By selecting the name (diagnosis), you will be linked to the introduction section of this Diagnostic Guide dedicated to the selected fracture eponym.

Fractures of the carpal bones account for ~6% of fractures overall and up to 18% of all hand fractures. The vast majority (58-89%) occurs in the scaphoid, while fractures of the other 7 carpals are uncommon and only comprise ~1.1% of all fractures. Trapezium fractures make up 1-5% of all carpal fractures, but these injuries are important to detect and treat appropriately due to the crucial role of the trapezium in thumb carpometacarpal (CMC) movements. The mechanism of injury is believed to be either indirect trauma—such as a fall on an outstretched hand (FOOSH)—that compresses the trapezium between the thumb metacarpal and radial styloid, or a direct trauma in which the thumb is driven into the trapezium. Although isolated trapezium fractures do occur, they are more commonly seen with other injuries, such as Rolando’s and Bennett’s fractures, or fractures of the scaphoid, capitate, or metacarpals. Conservative treatment is often indicated for most nondisplaced fractures, while surgery is required in displaced cases and those that cannot be reduced nonsurgically.1-5

Definitions

  • A trapezium fracture is a disruption of the mechanical integrity of the trapezium.
  • A trapezium fracture produces a discontinuity in the trapezium contours that can be complete or incomplete.
  • A trapezium fracture is caused by a direct force that exceeds the breaking point of the bone.

Hand Surgery Resource’s Fracture Description and Characterization Acronym

SPORADIC

S – Stability; P – Pattern; O – Open; R – Rotation; A – Angulation; D – Displacement; I – Intra-articular; C – Closed

S - Stability (stable or unstable)

  • Universally accepted definitions of clinical fracture stability are not well defined in the hand surgery literature.6-8
  • Stable: fracture fragment pattern is generally nondisplaced or minimally displaced. It does not require reduction, and the fracture fragment’s alignment is maintained with simple splinting. However, most definitions define a stable fracture as one that will maintain anatomical alignment after a simple closed reduction and splinting. Some authors add that stable fractures remain aligned, even when adjacent joints are put to a partial range of motion (ROM).
  • Unstable: will not remain anatomically or nearly anatomically aligned after a successful closed reduction and simple splinting. Typically unstable trapezium fractures have significant deformity with comminution, displacement, angulation, and/or shortening.
  • Longitudinal injuries at the thumb CMC joint are typically unstable and may be associated with subluxation of the thumb metacarpal.4

P - Pattern

  • Trapezium ridge (radial tubercle): typically isolated and caused by axial loading or avulsion by the transverse carpal ligament during a FOOSH injury2
    • Palmer classified trapezium ridge fractures into 2 types:
      • Type 1: involve the base of the ridge; typically heal with immobilization alone
      • Type 2: involve the tip of the ridge and are usually avulsion injuries that have a higher incidence for symptomatic nonunion10
  • Trapezium body: Usually result from an axial compression force from the thumb metacarpal and are accompanied by a Bennett’s fracture.3, 4, 12
    • horizontal, vertical, sagittal, coronal, and/or comminuted1, 3, 11
    • Vertical, intra-articular fractures are the most common pattern.
    • According to one study, about 20% of trapezium fractures are vertical sagittal split fractures.4
    • Horizontal fractures typically occur due to a horizontal shear load against the trapezium.3
  • Trapezium fractures can also be diagnosed using the Walker1, 13classification system:
    • Type I: horizontal body fracture
    • Type II: ridge fracture
    • Type IIa: involves the CMC joint
    • Type IIb: involves the scaphotrapezial joint
    • Type III: ulnar tubercle fracture
    • Type IV: vertical body fracture
    • Type V: comminuted body fracture
  • There is no consensus on the mechanism of injury of trapezium fractures, but it appears that most are caused by one of the two following forces:
    • An indirect trauma by a FOOSH, where the hand goes into hyperextension and radial deviation and the trapezium gets compressed between the base of the thumb metacarpal and radial styloid.
    • A direct trauma to the dorsoradial aspect of the hand in which the thumb is driven into the trapezium.4, 5

O - Open

  • Open: a wound connects the external environment to the fracture site. The wound provides a pathway for bacteria to reach and infect the fracture site. As a result, there is always a risk for chronic osteomyelitis. Therefore, open fractures of the trapezium require antibiotics with surgical irrigation and wound debridement.6, 14, 15
  • Many trapezium dislocations are open because they often result from a grinding or crushing force and there is a high likelihood of extensive associated soft tissue damage.16

R - Rotation

  • Trapezium fracture deformity can be caused by rotation of the distal fragment on the proximal fragment.
  • Degree of malrotation of the fracture fragments can be used to describe the fracture deformity.

A - Angulation (fracture fragments in relationship to one another)

  • Angulation is measured in degrees after identifying the direction of the apex of the angulation.
  • Straight: no angulatory deformity
  • Angulated: bent at the fracture site

D - Displacement (Contour)

  • Displaced: disrupted cortical contours
  • Nondisplaced: fracture line defining one or several fracture fragments; however, the external cortical contours are not significantly disrupted
  • In vertical trapezium fractures, displacement occurs frequently due to forces exerted by the abductor pollicis longus muscle.17

I - Intra-articular involvement

  • Fractures that enter a joint with one or more of their fracture lines.
  • Trapezium fractures can have fragment involvement with any of its CMC or intercarpal joint articulations.
  • If a fracture line enters a joint but does not displace the articular surface of the joint, then it is unlikely that this fracture will predispose to post-traumatic osteoarthritis. If the articular surface is separated or there is a step-off in the articular surface, then the congruity of the joint will be compromised and the risk of post-traumatic osteoarthritis increases significantly.
  • Vertical intra-articular trapezium fractures have been reported as the most common fracture pattern and usually result from an axial compression force from the thumb metacarpal.3

C - Closed

  • Closed: no associated wounds; the external environment has no connection to the fracture site or any of the fracture fragments.6-8

Trapezium fractures: named fractures, fractures with eponyms and other special fractures

Trapezium dislocations and fracture-dislocations

  • Trapezium dislocations are relatively rare, even among carpal dislocations. Most of these injuries occur concomitantly with a fracture of another surrounding bone—usually the scaphoid, trapezoid, capitate, thumb or index metacarpals, or distal radius—while isolated dislocations are possible but even less common.3, 16
  • The most common mechanisms of injury are a direct blow and a crush injury, and a high-energy force is typically needed to cause a trapezium dislocation. The trapezium’s strong dorsal ligamentous attachments ensure that a traumatic force will usually result in a thumb metacarpal fracture rather than a trapezium dislocation.16, 18
  • Trapezium dislocations tend to occur in either a volar or a radiodorsal direction, with the former being far more common because of the relative strength of the radial and palmar scaphotrapezial ligament complex.16, 19

Imaging

  • Oblique, pronated oblique, straight posteroanterior (PA), and Robert’s radiographic views are all particularly useful for identifying trapezium dislocations and fracture-dislocations.18, 19
    • Recognizing these injuries can be difficult because Gilula’s three arcs do not account for the position of the trapezium as originally described. Careful radiographic evaluation is therefore necessary.18
  • A CT scan may also be needed in certain suspected cases.18, 19

Treatment

  • There is no consensus regarding the optimal management of these injuries on account of their rarity, and current treatment recommendations are therefore unclear.9
  • Options include closed reduction with or without K-wire fixation and immobilization, open reduction with K-wire fixation, and salvage procedures.19
  • Conservative treatment using cast or splint immobilization may be possible if the joint is stable, but surgery is typically needed otherwise.9
  • Open reduction with K-wire fixation
    • Should be employed if the fracture is unstable or open, or if there is a failure to achieve adequate reduction. Some authors even advocate for it regardless of whether the injury is open or closed.16
  • Trapezium excision may be required in cases of isolated dislocation when reduction is not possible through other means, but this option is generally considered a salvage technique only and is rarely used.16
    • Arthrodesis is another salvage procedure that may be used when open reduction cannot be obtained or maintained.19

Complications

  • Decreased ROM
  • Decreased grip and pinch strength
  • Posttraumatic osteoarthritis
  • Osteonecrosis
  • Carpal instabilities

Outcomes

  • Outcomes after isolated trapezium dislocations are reduced are generally satisfactory, although loss of ROM and decreased grip and pinch strength may occur.19
  • In the majority of reported cases, percutaneous fixation using K-wires has been identified with acceptable results.16
  • Three reports have demonstrated excellent patient outcomes with closed reduction and percutaneous pinning (CRPP), while 7 cases have demonstrated excellent outcomes with open reduction and percutaneous fixation.18

Related Anatomy

  • The trapezium is an irregular-shaped bone located in the most radial position of the distal carpal row that consists of a ridge—or radial tubercle—a body, an ulnar tubercle, and a deep groove on its anterior surface. It articulates distally with the thumb metacarpal at the thumb CMC joint, medially with the index metacarpal at the index CMC joint and with the trapezoid at the triscaphe joint, and proximally with the scaphoid at the scaphotrapezial joint. The trapezium also forms the radial border of the carpal tunnel.
  • Ligamentous attachments of the trapezium include
    • Two layers of the flexor retinaculum, which attach on either side of its deep groove.
    • The anterior oblique ligament, which anchors the volar lip of thumb metacarpal to tubercle of the trapezium.
    • The radial collateral ligament and capsule of the thumb CMC joint, both of which attach to the lateral surface of the trapezium.
  • Tendons associated with the trapezium include the superficial head of flexor pollicis brevis, opponens pollicis, and abductor pollicis brevis tendons, all of which arise from the trapezium ridge.

Incidence and Related injuries/conditions

  • Fractures of the carpal bones have been found to account for 8-18% of all hand fractures,20, 21and ~6% of fractures overall.22
  • Fractures of the proximal carpals are more common than the distal carpals, and the most commonly fractured carpal bone is the scaphoid, which represents 58-89% of all carpal fractures.20, 21, 23, 24
  • Fractures of the other 7 carpals are very rare and only account for ~1.1% of all fractures. The triquetrum ranks highest of these bones, while fractures of the remaining carpals are even less common and vary in incidence.25-27
    • Trapezium fractures account for 1-5% of all carpal fractures.28, 29
    • According to one source, the trapezium is the third most commonly fractured carpal bone, but this statistic does not appear to be universally accepted.28
ICD-10 Codes

  • TRAPEZIUM FRACTURE

    Diagnostic Guide Name

    TRAPEZIUM FRACTURE

    ICD 10 Diagnosis, Single Code, Left Code, Right Code and Bilateral Code

    DIAGNOSISSINGLE CODE ONLYLEFTRIGHTBILATERAL (If Available)
    FRACTURE CARPAL BONE - TRAPEZIUM    
    - DISPLACED S62.172_S62.171_ 
    - NONDISPLACED S62.175_S62.174_ 

    Instructions (ICD 10 CM 2020, U.S. Version)

    THE APPROPRIATE SEVENTH CHARACTER IS TO BE ADDED TO EACH CODE FROM CATEGORY S62
     Closed FracturesOpen Type I or II or OtherOpen Type IIIA, IIIB, or IIIC
    Initial EncounterABC
    Subsequent Routine HealingDEF
    Subsequent Delayed HealingGHJ
    Subsequent NonunionKMN
    Subsequent MalunionPQR
    SequelaSSS

    ICD-10 Reference

    Reproduced from the International statistical classification of diseases and related health problems, 10th revision, Fifth edition, 2016. Geneva, World Health Organization, 2016 https://apps.who.int/iris/handle/10665/246208

Clinical Presentation Photos and Related Diagrams
  • Nondisplaced trapezial body fracture (arrow)
    Nondisplaced trapezial body fracture (arrow)
  • Displaced trapezial body fracture (arrow)
    Displaced trapezial body fracture (arrow)
  • Carpal tunnel view showing nondisplaced trapezial ridge fracture (arrow)
    Carpal tunnel view showing nondisplaced trapezial ridge fracture (arrow)
Symptoms
History of trauma with finger deformity or ecchymosis
Fracture pain, swelling and/or deformity
Decreased wrist range of motion and Impaired grip strength
Typical History

A typical patient is a 27-year-old, right-handed woman who is a frequent runner. While on a recent jog through the woods that took her on a downhill slope, she failed to notice a large branch in the middle of the trail and tripped over it. She landed with her hands outstretched and the left hand taking the brunt of the impact, which was hyperextended and radially deviated in the process. The trapezium in her left hand subsequently became compressed between the thumb metacarpal base and radial styloid, which resulted in a trapezial fracture.

Positive Tests, Exams or Signs
Work-up Options
Treatment Options
Treatment Goals
  • When treating closed trapezium fractures, the treating surgeon has 5 basic goals:6, 15
    1. A trapezium with a normal appearance. The X-ray may not need to be perfect, but the trapezium should have no obvious deformity (ie, the trapezium looks normal!)
    2. Avoid stiffness by maintaining a normal functional ROM (ie, the wrist works!)
    3. The trapezium is not painful (ie, the trapezium does not hurt!)
    4. Congruent joint surface with none-to-minimal joint surface irregularities (ie, the joints associated with the trapezium do not develop early posttraumatic arthritis!)
    5. Fracture care should minimize the risk for infection and osteomyelitis. This is mandatory for open fractures.
Conservative
  • There are no universal treatment recommendations for trapezium fractures, but it is generally agreed that most nondisplaced fractures and type 1 trapezial ridge fractures—those that involve the base of the ridge—can be treated conservatively with immobilization alone.
    • Immobilization is usually achieved with a thumb spica cast for 4-6 weeks, and periodic evaluation is necessary to detect any potential loss of reduction.2, 3, 12
Operative
  • Surgical treatment of trapezium fractures must always be an individualized therapeutic decision. However, surgical trapezium fracture care is most frequently recommended when:
    1. Closed reduction fails or the simple splint or cast immobilization does not maintain the reduction. For these irreducible or unstable fractures, operative treatment is recommended to achieve the 4 treatment goals of fracture care.
    2. There is a significantly displaced trapezium fracture fragment involving one of its associated joints. Surgical fracture care may be required in these cases.
    3. Open trapezium fractures require surgical care in the form of irrigation and debridement to prevent chronic infection.
  • Displaced trapezium fractures nearly always require surgery, especially because the potential for posttraumatic osteoarthritis is so high. Surgical options include CRPP, oblique external traction, open reduction and internal fixation (ORIF), fragment excision, external fixation with ligamentotaxis, and CMC joint arthroscopy.3
  • ORIF
    • Recommended for most vertically displaced intra-articular trapezium fractures, as well as those with CMC subluxation.12, 31
  • CRPP
    • Fixation methods include K-wires, headless screws, 3 mm cannulated screws, 1.5 mm cortical screws, and 2.7 mm screws.4
  • External fixation with ligamentotaxis
    • May be needed for comminuted trapezium fractures when internal fixation is not possible.4, 31
  • Fragment excision
    • May be required for cases of symptomatic nonunion, which is particularly likely with type 2 ridge fractures.3, 4
  • CMC joint arthroscopy
    • Useful for diagnosing and subsequently treating some trapezium fractures and associated arthritic conditions.5
Hand Therapy
  • The care and precautions related to immobilization devices for the trapezium fracture must be carefully reviewed with the patient. Patients should be educated regarding care and precautions. Patients should know that pain, especially increasing pain, numbness, tingling, skin irritation, splint loosening, or excessive splint tightness are red flags and should be reported to the surgeon or his team.
  • Pain should be managed with properly fitting splints, reassurance, elevation, ice in the initial post-fracture period, and mild pain medications. Patients should be encouraged to discontinue pain medication as soon as possible. Opioid use should be kept to a minimum.
  • If an infection does occur, management should focus on eradicating sepsis with thorough debridement, appropriate antibiotics (eg, cephalosporin, penicillin), and fracture stabilization, followed by obtaining fracture union and regaining a functional extremity.32
  • Patients should be instructed to carefully exercise all joints in the injured hand, wrist, and arm that do not require immobilization. Patients usually can exercise on their own; however, signs of generalized hand or wrist stiffness are indications for referral to hand therapy (PT or OT).
Complications
  • CMC joint stiffness with associated first web space contracture
  • Posttraumatic osteoarthritis
  • Nonunion
  • Carpal tunnel syndrome
  • Flexor carpi radialis tendinopathy
  • Painful loss of pinch strength and function
Outcomes
  • Positive outcomes have been identified after both conservative and surgical treatment methods.
  • In one study, 11 patients with types IV and V trapezium fractures were treated with open reduction and screw fixation.
    • Outcomes were excellent, with no statistical difference found in thumb or wrist motion, or grip/pinch strength between the injured and uninjured hands.31
  • Another small series of patients who underwent oblique external traction for trapezial body fractures demonstrated full and pain-free ROM of the thumb in and out of traction, with union at 8-10 weeks.33
  • One article reported successful outcomes of most nondisplaced trapezium fractures that were treated conservatively with plaster cast immobilization only,34while another trial demonstrated poor outcomes in patients with comminuted fractures treated in the same manner.35
Key Educational Points
  • Underlying pathological conditions such as bone tumors—like enchodromas—and osteoporosis should be expected in fractures that occur from trivial trauma.
  • The functional needs of each patient must be considered when recommending treatment for trapezium fractures.
  • Although non-scaphoid carpal bones like the trapezium have received considerably less attention than the scaphoid, these injuries can still produce morbidity that is disproportionate to their incidence for 2 primary reasons:
    • These fractures may have a subtle clinical and radiographic presentation and are easily overlooked or misdiagnosed, in some cases as wrist sprains. This can lead to suboptimal management and poor long-term outcomes with significant wrist disability.
    • These fractures are often harbingers of significant ligamentous disruption or associated carpal fractures, and failure to recognize a more global injury pattern can result in undertreatment and permanent wrist dysfunction.2
  • The clinical presentation of trapezium fractures can vary considerably depending on fracture displacement and involvement of the CMC joint: Some patients only have minor pain at the base of the thumb, while others experience swelling, gross deformity, and severe restriction of movement.12
  • Carpal tunnel, pronated AP, Robert’s, and Bett’s X-ray views are all helpful for identifying these injuries and may be required if routine views are unsuccessful and clinical suspicion remains.3, 4
  • CT scan may be required if the diagnosis is still in question.5  CT scans provide greater delineation of the size and degree of displacement of fracture fragments, and the extent of articular involvement.3
  • Trapezium fractures are often easily overlooked in the emergency room due to their rarity and the complex arrangements of the carpal bones.
  • Standard anteroposterior (AP), lateral, and oblique X-ray views sometimes fail to detect many trapezium fractures, especially those of the trapezial ridge.
  • Trapezial body fractures are also difficult to detect on routine radiographs because of the overlap by the trapezoid shadow.4
References

New and Cited Articles

  1. Alonso, L. and Couceiro, J. Comminuted Fracture of the Body of the Trapezium and Thumb Carpometacarpal Dislocation: A Particular Pattern. Surg J (N Y) 2018;4:e34-e36. PMID: 29532037
  2. Shah, M. A. and Veigas, S. F. Fractures of the carpal bones excludng the scaphoid. J Am Soc Surg Hand 2002;2:129-41.
  3. Suh, N., Ek, E. T. and Wolfe, S. W. Carpal fractures. J Hand Surg Am 2014;39:785-91. PMID: 24679911
  4. Suresh, S. Isolated coronal split fracture of the trapezium. Indian J Orthop 2012;46:99-101. PMID: 22345815
  5. Wiesler, E. R., Chloros, G. D. and Kuzma, G. R. Arthroscopy in the treatment of fracture of the trapezium. Arthroscopy 2007;23:1248 e1-4. PMID: 17986420
  6. Cheah, A. E. and Yao, J. Hand Fractures: Indications, the Tried and True and New Innovations. J Hand Surg Am 2016;41:712-22.PMID: 27113910
  7. Nesbitt, K. S., Failla, J. M. and Les, C. Assessment of instability factors in adult distal radius fractures. J Hand Surg Am 2004;29:1128-38.PMID: 15576227
  8. Walenkamp, M. M., Vos, L. M., Strackee, S. D., et al. The Unstable Distal Radius Fracture-How Do We Define It? A Systematic Review. J Wrist Surg 2015;4:307-16. PMID: 26649263
  9. Roger, J., Mathieu, L., Mottier, F., et al. Trapeziometacarpal joint dislocation complicated by a trapezium fracture: A case report and literature review. Hand Surg Rehabil 2016;35:288-291. PMID: 27781994
  10. Palmer, A. K. Trapezial ridge fractures. J Hand Surg Am 1981;6:561-4. PMID: 7310078
  11. Binhammer, P. and Born, T. Coronal fracture of the body of the trapezium: a case report. J Hand Surg Am 1998;23:156-7. PMID: 9523970
  12. Ramoutar, D. N., Katevu, C., Titchener, A. G., et al. Trapezium fracture - a common technique to fix a rare injury: a case report. Cases J 2009;2:8304. PMID: 19918416
  13. Walker, J. L., Greene, T. L. and Lunseth, P. A. Fractures of the body of the trapezium.J Orthop Trauma 1988;2:22-8. PMID: 3225697
  14. Ketonis, C., Dwyer, J. and Ilyas, A. M. Timing of Debridement and Infection Rates in Open Fractures of the Hand: A Systematic Review. Hand (N Y) 2017;12:119-126. PMID: 28344521
  15. Meals, C. and Meals, R. Hand fractures: a review of current treatment strategies. J Hand Surg Am 2013;38:1021-31. PMID: 23618458
  16. Kenyon, R. M., Kelly, E. G. and Padinjarathala, B. Traumatic Isolated Trapezium Dislocation without Fracture: A Case Report and Review of the Literature. Case Rep Orthop 2016;2016:1798941. PMID: 27099798
  17. Jones, J. A. and Pellegrini, V. D., Jr. Transverse fracture-dislocation of the trapezium. J Hand Surg Am 1989;14:481-5.PMID: 2738334
  18. Harris, A. P., Goodman, A. D., Gil, J. A., et al. The Trapezium Dislocation: Case Presentation, Review of the Literature, Radiographic Analysis, Proposed Classification, and Treatment. Hand (N Y) 2017, 10.1177/15589447177443391558944717744339. PMID: 29185813
  19. Clarke, S. E. and Raphael, J. R. Combined dislocation of the trapezium and the trapezoid: a case report with review of the literature. Hand (N Y) 2010;5:111-5. PMID: 19707835
  20. Hove, L. M. Fractures of the hand. Distribution and relative incidence. Scand J Plast Reconstr Surg Hand Surg 1993;27:317-9.PMID: 8159947
  21. van Onselen, E. B., Karim, R. B., Hage, J. J., et al. Prevalence and distribution of hand fractures. J Hand Surg Br 2003;28:491-5.PMID: 12954264
  22. Dobyns, J. H., Beckenbaugh, R. D., Bryan, R. S., et al.Fractures of the Hand and Wrist. In: J. E. Flynn,Hand Surgery.Philadelphia: Lippincott Williams & Wilkins, 1982.
  23. Hey, H. W., Chong, A. K. and Murphy, D. Prevalence of carpal fracture in Singapore. J Hand Surg Am 2011;36:278-83. PMID: 21276891
  24. Rhemrev, S. J., Ootes, D., Beeres, F. J., et al. Current methods of diagnosis and treatment of scaphoid fractures. Int J Emerg Med 2011;4:4. PMID: 21408000
  25. Garcia-Elias, M. Dorsal fractures of the triquetrum-avulsion or compression fractures? J Hand Surg Am 1987;12:266-8. PMID: 3559084
  26. Hocker, K. and Menschik, A. Chip fractures of the triquetrum. Mechanism, classification and results. J Hand Surg Br 1994;19:584-8.PMID: 7822914
  27. Larsen, C. F., Brondum, V. and Skov, O. Epidemiology of scaphoid fractures in Odense, Denmark. Acta Orthop Scand 1992;63:216-8.PMID: 1590062
  28. Pointu J, Schwenck JP, Destree G and Séjourné P. [Fractures of the trapezium. Mechanisms. Anatomo-pathology and therapeutic indications]. Rev Chir Orthop Reparatrice Appar Mot1988;74(5):454-65. PMID: 3065849
  29. Kose O, Keskinbora M and Guler F. Carpometacarpal dislocation of the thumb associated with fracture of the trapezium. J Orthop Traumatol2015;16(2):161-5. PMID: 24671487
  30. Tolat AR and Jones MW. Carpometacarpal dislocation of the thumb associated with fracture of the trapezium. Injury1990;21(6):411-2. PMID: 2276813
  31. McGuigan, F. X. and Culp, R. W. Surgical treatment of intra-articular fractures of the trapezium. J Hand Surg Am 2002;27:697-703.PMID: 12132098
  32. Day, C. S.Fractures of the Metacarpals and Phalanges. In: D. P. Green,Green's Operative Hand Surgery.Philadelphia: Elsevier, 2016.
  33. Gelberman RH, Vance RM and Zakaib GS. Fractures at the base of the thumb: treatment with oblique traction. J Bone Joint Surg Am1979;61(2):260-2. PMID: 422612
  34. Van Schil P and De Smet C. Simultaneous fracture of carpal scaphoid and trapezium. J Hand Surg Br1986;11(1):112-4. PMID: 3958529
  35. Jones WA and Ghorbal MS. Fractures of the trapezium. A report on three cases. J Hand Surg Br1985;10(2):227-30. PMID: 4031609

Reviews

  1. Kohyama S, Tanaka T, Ikumi A, et al. Trapezium Fracture Associated with Thumb Carpometacarpal Joint Dislocation: A Report of Three Cases and Literature Review. Case Rep Orthop2018;2018:2408708. PMID: 29682377
  2. Panigrahi R, Biswal MR, Palo N and Panigrahi N. Isolated Coronal Fracture of Trapezium- A Case Report with Review of Literature. J Orthop Case Rep;5(3):29-31. PMID: 27299062

Classics

  1. Bendell JL. ISOLATED SPRAIN-FRACTURE OF THE TRAPEZIUM PRODUCED BY INDIRECT VIOLENCE. Ann Surg1917;65(3):364-6. PMID: 17863682
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