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Upper limb symptoms and signs
Published in Kevin G Burnand, John Black, Steven A Corbett, William EG Thomas, Norman L Browse, Browse’s Introduction to the Symptoms & Signs of Surgical Disease, 2014
Kevin G Burnand, John Black, Steven A Corbett, William EG Thomas, Norman L Browse
A Galeazzi fracture occurs when there is a fracture between the middle and distal thirds of the radius, accompanied by a subluxation/dislocation of the distal radio-ulnar joint (Fig. 7.42a).
Palmar fracture-dislocation of the trapezoid with median nerve contusion. Case report and literature review
Published in Case Reports in Plastic Surgery and Hand Surgery, 2021
Sara Montanari, Leone Pangallo, Annalisa Valore, Roberto Adani
Complete palmar dislocation of the trapezoid is a rare injury resulting from high-energy trauma. Our review of the English literature in PubMed database found twelve reports on this topic, all reported in Table 1 [1–12]. Only two of these patients had an isolated injury [6,9]. The other reports had associated injuries, including several cases of metacarpal fractures or carpometacarpal dislocations, some cases of intercarpal dislocations, one case of open dislocation [4], one case of Galeazzi fracture [10], one case of attritional rupture of the flexor tendons to the index finger [8] and one case of acute carpal tunnel syndrome [1]. Recent literature has attempted to provide improved description of the traumatic mechanism, but it is still unclear. The trapezoid is a wedge-shaped bone whose dorsal surface area is about twice of its volar surface area. It is in a well-protected position between the trapezium, scaphoid, capitate, and index metacarpal and has strong ligament attachments that bind it to the adjacent bones. The volar intercarpal ligaments are the strongest. Consequently, injuries to the trapezoid are rarely seen and there is no clear explanation as to how a wedge-shaped bone wider dorsally dislocates palmarly. In fact, two-third of these injuries are dorsal dislocations [1,11]. The mechanism postulated for dorsal dislocations is a force applied to the distal dorsal end of the second metacarpal with the wrist in slight flexion. This force acts as a lever and displaces the trapezoid, allowing the proximal migration of second metacarpal toward the scaphoid and the scaphotrapezial joint. The trapezium and the trapeziometacarpal complex may dislocate radially and proximally. Disruption of the scaphotrapezial joint as proposed by Laing et al. [13] could represent the extension of the trapezoid dislocation mechanism. Palmar dislocation of the trapezoid has been postulated to occur by means of a direct blow on the dorsal trapezoid causing flattening of the carpal arch and extrusion of the trapezoid or by forced hyperextension of the midcarpal joint [14]. To our knowledge, the current case represents the first description of fracture and complete palmar dislocation of the trapezoid with acute carpal tunnel syndrome. The singularity of a significant displacement of the fracture and the association with multiple carpometacarpal dislocations and scapho-trapezium joint dislocation are also present. In this case, preoperative radiographs obtained in the emergency department including a posteroanterior view of the hand and a lateral view of the wrist (Figure 1) provided an incomplete diagnosis. We were not able to visualize the correct location of trapezoid on the standard preoperative views because of overlap. Even in case of a slight displacement, the bone superposition of carpal bones and the common presence of several associated injuries make CT scan often necessary and generally recommended [15].