Two-stage management of traumatic comminuted trapezium fracture with severe bone defect: a case report and literature review.

BACKGROUND: Trapezium fractures are rare carpal injuries, and comminuted intra-articular patterns with severe bone loss are exceptionally uncommon and challenging, with no established consensus; patient-specific 3D printing may offer a reconstructive option. CASE PRESENTATION: We report a 51-year-old man who sustained a transfixing nail-gun injury, resulting in severe right wrist pain and limited thumb motion. Imaging showed a comminuted trapezium fracture with severe bone loss. The patient underwent stage I debridement, antibiotic-loaded bone cement spacer placement, and external fixation, followed by stage II implantation of a custom 3D-printed trapezium prosthesis. At the 9-month follow-up, he had satisfactory thumb and wrist motion and had resumed activities of daily living. DISCUSSION AND CONCLUSION: This case describes a staged reconstructive strategy for traumatic comminuted trapezium fracture with severe bone loss. This approach may be considered in carefully selected severe trapezial bone defect cases when conventional fixation or bone grafting is unlikely to restore joint congruity and thumb motion. Long-term follow-up is required to evaluate implant survival and late complications.