Open complete dislocation of trapezium with a vertically split fracture: a case report

Open complete dislocation of the trapezium is an extraordinarily rare injury with only a few cases reported so far in literature. The association of a vertically split fracture makes this injury even rare and hence worth reporting. A 14 year old Kashmiri boy presented to us with a history of massive trauma to the non dominant left hand sustained as a result of a blow from a heavy hammer. The thenar area was burst out and the trapezium was vertically split apart into two halves which were dislocated from the articular surfaces of the scaphoid as well as the first metacarpal. The mechanism of injury as in other such reported cases was a massive direct force localized over the carpal bone which causes its enucleation and fracture. Although some authors have recommended excision of the dislocated trapezium, open reduction of the fracture dislocation and fixation with K wires was carried out under General anesthesia. At the end of one year although there was some functional deficit in the affected thumb, especially in opposition, the patient was quite satisfied with the outcome as this was the non dominant hand.