Rare case of isolated trapezoid fracture: a case report

Isolated trapezoid fractures are extremely rare, accounting for only 0.2%-0.4% of all carpal fractures. Due to their infrequency and vague clinical presentation, these fractures are often overlooked in initial assessments. The strong ligamentous connections of the trapezoid contribute to its inherent stability, making fractures uncommon.

A middle-aged man presented with persistent wrist pain for 2 months following a fall on an outstretched hand. Initial radiographs were unremarkable, leading to conservative treatment. However, persistent symptoms prompted further evaluation using computed tomography (CT) and MRI, which confirmed a nondisplaced linear trapezoid fracture. The patient was managed conservatively with 6 weeks of immobilization using an arm-thumb spica, along with analgesics and anti-inflammatory medications.

The rarity of isolated trapezoid fractures may be attributed to underdiagnosis or the bone's stable anatomical position. Standard radiographs often fail to detect these fractures, making advanced imaging techniques such as CT and MRI essential for diagnosis. Conservative management is generally preferred for nondisplaced fractures, while surgical intervention may be required for displaced or unstable cases. Timely diagnosis and treatment are critical to prevent complications such as nonunion, malunion, and chronic pain.

Isolated trapezoid fractures, though rare, should be considered in cases of persistent wrist pain with negative initial radiographs. Advanced imaging plays a crucial role in diagnosis, and conservative management often leads to favorable outcomes. Early recognition and appropriate treatment help prevent long-term functional impairment.