Trapezium Fracture

The trapezium is a saddle-shaped bone that is adjacent to the thumb metacarpal. Injuries are produced by a direct blow to the thumb or from a dorsiflexion and radial deviation force. Vertical fractures are rare and are an analog of a Bennett's fracture (an intra-articular proximal thumb metacarpal fracture). Thumb movement is painful. There is tenderness at the apex of the anatomical snuffbox and at the base of the thenar eminence. This injury is best profiled on a 20-degree pronated oblique view. Nondisplaced fractures are treated in a thumb spica cast or splint for six weeks. Displaced fractures require open reduction and internal fixation. The major complication is nonunion.

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