Traumatic Dorsal Dislocation of the Trapezium: Surgical Management of a Rare Hand Injury

Isolated dorsal dislocation of the trapezium is an exceptionally rare carpal injury, typically secondary to high-energy trauma, and carries a high likelihood of being overlooked during the initial radiographic evaluation. Its identification requires careful assessment of carpal alignment, particularly the Gilula arcs, as radiographic alterations may be subtle. Trapezial stability depends on a complex capsuloligamentous system, with the dorsoradial ligament playing a key role; disruption of this structure permits dorsoradial displacement of the bone and results in joint instability. We present the case of a 58-year-old male who sustained high-energy trauma following a motorcycle accident, with direct impact to the left hand. Eight days later, he sought medical evaluation. AP and oblique radiographs demonstrated carpometacarpal dislocation with dorsal displacement of the trapezium, without apparent associated fractures. Given the observed instability, a dorsal surgical approach was performed, followed by open reduction and stabilization using three Kirschner wires. The immediate postoperative course demonstrated adequate restoration of articular congruity and satisfactory carpal alignment. The literature indicates that delayed diagnosis may hinder anatomical reduction due to perilesional fibrosis and increase the likelihood of salvage procedures, such as trapeziectomy, with potential functional consequences. Early recognition and prompt surgical stabilization allow preservation of the trapezium, restoration of thumb biomechanics, and reduction of the risk of chronic instability and post-traumatic osteoarthritis.