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Open transtrapezium injuries of the thumb are not common and sufficiently described injuries. We have clinically and radiologically evaluated six patients with transtrapezium injury of the thumb. The average follow-up time was 65 months. All injuries occurred in young people, who had high-energy trauma to their thumb. Fracture of the trapezium with exposure of the first carpometacarpal joint was a constant along with soft tissue damage. The latter included thumb tendons, digital nerves and arteries, motor branch of the median nerve, palmar or dorsal branch of the radial artery, and thenar musculature. All trapezium fractures were fixed with mini 1.5 mm screws. All the other injured structures were repaired by microsurgical techniques. Physiotherapy protocols with emphasis to electrostimulation were used within 2 weeks postoperatively. Clinical assessment included objective and subjective criteria, which revealed moderate loss of motion because of musculature loss either by direct trauma or by denervation. No correlation was found between types of trapezium fracture and disability. Internal osteosynthesis with 1.5 mini cortical screws provided excellent stability. Despite the severity of the initial trauma the results were surprisingly good.