Aldeeb Maya, Aminake Ghislain N, Khalil Ibrahim A, Hayton Mike, Ksantini Om El Khir, Hagert Elisabet
Department of Medical Education, Family Medicine Residency Program, Hamad Medical Corporation, Doha, Qatar.
Aspetar Orthopedic and Sport Medicine Hospital, Doha, Qatar.
J Hand Surg Glob Online. 2023 Oct 31;6(1):46-52. doi: 10.1016/j.jhsg.2023.09.001. eCollection 2024 Jan.
Isolated trapezoid fractures are rare injuries, particularly among adolescents, constituting only 0.4% of all carpal bone fractures. This study aims to present two cases of isolated trapezoid fracture in adolescent goalkeepers and a scoping review of the literature to provide guidelines for the management of this injury.
Following PRISMA-ScR guidelines, a scoping review of reported cases was conducted. Two hundred and twenty articles were found using PubMed and Google Scholar. After full-text review, a total of 30 cases from 22 articles along with our 2 cases were analyzed based on demographics, injury mechanism, method/timing of diagnosis, prognosis, and time to recovery.
Thirty-two reported cases of trapezoid fractures with a mean age of 26.7 years (75% male) were found, with pain as the most common presenting symptom. A majority (78%) had initial negative findings on radiography, and the diagnosis was primarily established through computed tomography (59%; n = 19) or magnetic resonance imaging (50%; n = 16). There was a substantial delay in diagnosis (mean 26 days), primarily because computed tomography/magnetic resonance imaging was frequently ordered late. The majority of cases (78%) were managed conservatively, with immobilization periods ranging from 4 to 12 weeks. The average duration for full recovery was 4.5 months, with operative management taking 7.3 months and conservative management taking 3.5 months.
Trapezoid fractures, though rare, are often not promptly diagnosed on initial plain radiographs, leading to a potential underreporting of cases. Because of the risk of complications associated with this type of injury, clinicians should maintain a high level of vigilance and consider trapezoid fracture as a possible differential diagnosis when presented with carpal pain, swelling, or limited movement, particularly after axial load incidents. Further research and guidelines are needed to enhance our understanding and management of this uncommon injury in the future.
TYPE OF STUDY/LEVEL OF EVIDENCE: Differential diagnosis/symptom prevalence IIIb.
孤立性梯形骨骨折是一种罕见的损伤，在青少年中尤为少见，仅占所有腕骨骨折的0.4%。本研究旨在介绍两例青少年守门员孤立性梯形骨骨折病例，并对文献进行范围综述，以提供该损伤的治疗指南。
遵循PRISMA-ScR指南，对报告的病例进行范围综述。通过PubMed和谷歌学术搜索到220篇文章。经过全文审查，基于人口统计学、损伤机制、诊断方法/时间、预后和恢复时间，对22篇文章中的30例病例以及我们的2例病例进行了分析。
共发现32例报告的梯形骨骨折病例，平均年龄26.7岁（75%为男性），最常见的症状是疼痛。大多数（78%）患者最初的X线检查结果为阴性，诊断主要通过计算机断层扫描（59%；n = 19）或磁共振成像（50%；n = 16）确定。诊断存在显著延迟（平均26天），主要原因是计算机断层扫描/磁共振成像检查经常安排得较晚。大多数病例（78%）采用保守治疗，固定期为4至12周。完全恢复的平均时长为4.5个月，手术治疗为7.3个月，保守治疗为3.5个月。
梯形骨骨折虽罕见，但最初的普通X线片常不能及时诊断，可能导致病例报告不足。由于此类损伤存在并发症风险，临床医生应保持高度警惕，当出现腕部疼痛、肿胀或活动受限，尤其是在轴向负荷事件后，应考虑梯形骨骨折作为可能的鉴别诊断。未来需要进一步研究和制定指南，以加强我们对这种罕见损伤的认识和治疗。
研究类型/证据水平：鉴别诊断/症状患病率IIIb。
