Surgical treatment of intra-articular fractures of the trapezium.

Eleven patients with intra-articular fractures of the trapezium were evaluated after surgical treatment with a mean follow-up time of 47 months (range, 25-80 mo). There were 6 vertical split and 5 comminuted fractures. All fractures involved high-energy trauma in men. Five resulted from motorcycle accidents. An associated Bennett's fracture occurred in 4 patients. Three fractures went undiagnosed at the time of initial evaluation. At late follow-up evaluation, 8 of 11 patients experienced some pain, mainly at the trapeziometacarpal articulation. There was no statistical difference in thumb motion, wrist motion, or grip and pinch strength between the affected and unaffected extremity. Radiographs revealed degenerative changes at the trapeziometacarpal articulation in 5 of 11 fractures. No patient was disabled and no patient changed occupation as a result of the hand injury. Based on the good results obtained with surgical intervention we advocate open reduction and internal fixation for fractures with either articular displacement >2 mm or carpometacarpal subluxation.