Two Cases of Conservative Treatment for Fractured Trapezial Tubercles

Among non-scaphoid carpal fractures, trapezium fractures are uncommon but rank as the third or fourth most frequent. A few international studies suggest that these fractures represent 1.5-3% of fractures of the hand. There are very few reports on the conservative treatment of patients with this type of injury owing to various complications. Herein, we present two cases of trapezial tubercle fractures managed conservatively with thumb spica casting. In Case 1, a 52-year-old male lost control and fell from his motorcycle, resulting in an injury to his right hand. On the following day, he presented to the Kamiaoki Clinic of Orthopedic Surgery, SBC Tokyo Medical University, where computed tomography (CT) revealed a non-displaced fracture of the trapezial tubercle. The patient was fitted with a thumb spica cast and discharged. A follow-up CT obtained six weeks after the injury revealed callus formation without displacement, and the patient's clinical course was uneventful. In Case 2, an 88-year-old woman experienced a fall and injury to the right hand. On the following day, she presented to the Kamiaoki Clinic of Orthopedic Surgery, SBC Tokyo Medical University. Plain radiographs demonstrated a fracture line suggestive of a trapezial injury, and CT confirmed a non-displaced fracture of the trapezial tubercle. The patient was fitted with a thumb spica cast and discharged. Although a CT scan obtained four weeks after the injury showed no obvious callus formation, there was no exacerbation of the fracture; therefore, the spica cast was removed. At the final follow-up, nine weeks after the initial injury, the patient had no difficulty performing activities of daily living. Although previous studies have generally reported satisfactory outcomes following conservative treatment of trapezial tubercle fractures, non-union has also been described and is sometimes considered an indication for surgical intervention. In Case 2, although bony union was not radiographically confirmed, a satisfactory functional outcome was achieved. Given the patient's advanced age and the higher risk of joint stiffness, the clinical decision to prioritize early mobilization over radiographic union may have facilitated the preservation of her activities of daily living. While Case 1 and Case 2 differ in age and fracture type, Case 2 illustrates that in certain elderly patients with minimally displaced trapezial tubercle fractures, acceptable function can be maintained even without definitive bony union.