Isolated Trapezoid Nonunion: Case Report of a Rare Injury and Review of Literature.

Trapezoid fractures are rare injuries with few descriptions of surgical treatment in the literature. We present a case of trapezoid nonunion in a 23-year-old male who injured his hand at work. Initial radiographs did not demonstrate a fracture. However, a bone scan and computed tomography (CT) scan revealed a nonunion 6 months after the initial injury. The patient had continued pain and therefore open reduction and internal fixation with distal radius bone grafting was performed. Postoperatively, he underwent immobilization with a short arm cast and used a bone stimulator. After 6 months of surgery, the patient was pain-free and was back to work without restrictions. After a review of 21 isolated, minimally displaced trapezoid fractures reported in the current literature, we speculate delayed diagnosis and a lack of early immobilization can put relatively young and healthy individuals at risk for fracture nonunion. We therefore suggest early diagnosis with CT scans, magnetic resonance imaging (MRI), early treatment with immobilization, and close follow-up when there is high suspicion of occult trapezoid fracture.