A 28-year-old male with no significant medical history presented to our emergency room five days after sustaining a right-hand injury from a fall on an outstretched hand while playing basketball. On examination, there was swelling and tenderness on palpation at the base of the right thumb. Right hand radiographs (Figure 1) and CT with 3D reconstruction (Figure 2) showed a comminuted trapezium fracture.
The patient was taken to the operating room seven days after his initial injury. A dorsal radial approach was used to expose the trapezium protecting the radial sensory nerves, radial arteries and EPL and EPB tendons. After exposing the trapezium, we reduced the fracture with a dental pick and provisional Kirschner wires. C arm was utilized throughout the procedure to confirm fracture and joint reduction as well as to appropriately size the screw. A 2 mm headless compression screw (HCS, Synthes Inc, West Chester, PA, USA) was utilized to definitively fix the fracture (Figure 3).
Intraoperatively, there was excellent stability of the fracture and restoration of the articular surface.
The patient's joint was immobilized with a thumb spica splint for two weeks. Unrestricted range of motion exercises as well as occupational therapy were initiated two weeks following surgery. Three months after surgery, repeated X-rays showed a healed trapezium fracture (Figure 4). During this time, his DASH score was 10 and his SANE score was 95.
The patient demonstrated full range of motion of the thumb (Figure 5) and returned to all previous activities.