Wrist #2 - Answers

  1. Fracture of the trapezium (greater multangular)

Findings

  1. Incongruity of both joint surfaces of the trapezium
  2. "Double density" in trapezium due to overlapping fracture fragments
  3. Apparent widening of the trapezium due to displacement of the fracture fragments


AP and lateral views of the left wrist

Click either image for a more detailed view.

Brief Discussion

This is not a terribly common fracture, but looks pretty much like most other carpal fractures. If the X-ray beam is not parallel to the fracture plane, as in this case, one may not see a distinct fracture line on the film. The CT images below were ordered by the orthopedic surgeon to better visualize this fracture and to help in surgical planning.


Direct coronal and sagittal CT of the 1st carpometacarpal joint

Click either image for a more detailed view.

What was done for this injury? The surgeon elected to reduce the fracture and to fuse the trapezial fragments to the base of the 1st metacarpal, as shown below.


Postoperative view of the wrist following carpometacarpal fusion -- also note the lucent defect in the distal radius, which represents a bone graft donor site

Click the image for a more detailed view.

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Used by permission of Michael L. Richardson, M.D. (mrich@u.washington.edu)
© University of Washington Department of Radiology