Solitary osteochondroma of the trapezoid disguised as a tooth fragment

Fight bite injuries of the hand are common presentations in A&E departments and usually result from a fist blow to the mouth. The authors report a case of a 24-year-old man who presented 6 weeks after an injury to his right wrist following an altercation. Radiographic examination and CT scans were in keeping with a tooth fragment embedded in the trapezoid. However, post excision histology subsequently revealed the lesion to be a solitary osteochondroma of the trapezoid. Osteochondromas are benign lesions of bony or cartilaginous origin and are usually found in the metaphyseal region of long bones. They represent by far the most common primary bone tumours. However, osteochondromas arising from the carpal bones are extremely rare with very few cases reported in the literature. This case illustrates the need to include 'tumour' as a differential diagnosis in every unusual appearing bony lesion, even if there is a history of trauma.