Our Summary

This research paper is about fractures in a small wrist bone called the trapezium. These fractures are hard to see on regular x-rays after someone hurts their wrist. However, when using high-resolution cross-sectional imaging, trapezium fractures are the most common kind of wrist bone fracture that isn’t seen on x-rays.

The researchers used a method called Cone beam CT on patients who were suspected to have a hidden wrist fracture after an injury. They found 93 hidden wrist fractures in 166 patients, and the most frequently fractured bone was the trapezium, which made up 20.4% of all wrist fractures. In most cases, the trapezium fractures involved the volar ridge (the front part of the bone).

Interestingly, in 84% of the cases where the trapezium was fractured, doctors initially thought the patient had fractured a different wrist bone called the scaphoid.

Therefore, the study concludes that trapezium fractures are actually more common than what is currently reported in medical literature. If a patient comes in with wrist pain after an injury, but their x-ray doesn’t show a fracture, it’s more likely that they have a trapezium fracture than a scaphoid one. The researchers suggest that doctors should be more aware of this, and consider using cross-sectional imaging in all cases of wrist pain where the x-ray doesn’t show a fracture.

FAQs

  1. What is the most common carpal bone fracture that is often missed in plain radiographs after acute wrist trauma?
  2. What is the frequency of trapezium fractures in patients with acute trauma and negative radiographs?
  3. Why should cross-sectional imaging be considered in all cases of post-traumatic wrist pain with negative radiographs?

Doctor’s Tip

A helpful tip a doctor might tell a patient about scaphoid fracture surgery is to follow post-operative instructions carefully, including keeping the wrist immobilized as directed, attending follow-up appointments, and participating in physical therapy to help regain strength and range of motion in the wrist. It is important to communicate any concerns or changes in symptoms to your healthcare provider to ensure proper healing and recovery.

Suitable For

Patients with suspected radiographically occult wrist fractures following acute trauma are typically recommended scaphoid fracture surgery. In particular, patients with fractures of the trapezium, which are the most common radiographically occult carpal bone fractures, may benefit from surgery to properly diagnose and treat the injury. Additionally, patients with high levels of clinical suspicion for scaphoid injuries, even if initial radiographs are negative, should also consider surgery to assess and potentially repair any fractures. Awareness of the types and mechanisms of trapezium fractures is important in determining the appropriate treatment approach for patients with acute wrist trauma.

Timeline

  • Patient experiences acute wrist trauma
  • Initial assessment suspects scaphoid fracture
  • Negative radiographs lead to further imaging with cone beam CT
  • Trapezium fracture is identified as the most common carpal bone fracture
  • Surgery may be recommended depending on the severity of the fracture
  • Post-surgery, patient undergoes rehabilitation and physical therapy for recovery
  • Follow-up appointments and imaging may be scheduled to monitor healing progress.

What to Ask Your Doctor

  1. What is the best treatment option for my specific scaphoid fracture?
  2. What are the risks and benefits of scaphoid fracture surgery?
  3. How long will the recovery process take after scaphoid fracture surgery?
  4. What type of anesthesia will be used during the surgery?
  5. Will I need to undergo physical therapy after scaphoid fracture surgery?
  6. What are the potential complications associated with scaphoid fracture surgery?
  7. How successful is scaphoid fracture surgery in terms of long-term outcomes?
  8. Will I need to have any follow-up appointments or imaging studies after the surgery?
  9. Are there any restrictions or limitations I should be aware of during the recovery period?
  10. What can I do to help promote healing and prevent future injuries to my scaphoid bone?

Reference

Authors: Gibney B, Murphy MC, Ahern DP, Hynes D, MacMahon PJ. Journal: Emerg Radiol. 2019 Oct;26(5):531-540. doi: 10.1007/s10140-019-01702-2. Epub 2019 Jun 27. PMID: 31250231