Carpal fractures: Difference between revisions
 
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== Background ==
==Background==
*Scaphoid fractures account for 70% of all carpal fractures  
[[File:Carpal bones.png|thumb|Carpal bones]]
[[File:Zone_of_Vulnerability.jpg|thumb|Zone of Vulnerability]]
*[[Scaphoid fracture|Scaphoid fractures]] account for 70% of all carpal fractures  
*Ulnar nerve damage associated with fractures of hamate or pisiform  
*Ulnar nerve damage associated with fractures of hamate or pisiform  
*50% of pisiform fx associated with injury to distal radius or other carpal bone  
*50% of pisiform fracture associated with injury to distal radius or other carpal bone  
*If bone fragment seen posterior to carpus on lateral, very likely triquetrum fx
*If bone fragment seen posterior to carpus on lateral, very likely triquetrum fracture


==Overview==
==Fracture Types==
{{Carpal fractures}}


{| width="300" border="1" cellpadding="1" cellspacing="1"
==Evaluation==
|-
[[Image:Wrist_-_Lateral.jpg|thumb|Lateral view]]
! scope="col" | Carpal Bone
*Evaluate Zone of Vulnerability (see picture)
! scope="col" | Mechanism of Injury
! scope="col" | Examination
! scope="col" | ED Management<br>
|-
| Scaphoid
| FOOSH
| Snuffbox tenderness;<br>pain w/ radial deviation/flexion
| Short arm, thumb spica, in dorsiflexion w/ radial deviation
|-
| Triquetrum
|  
1. Avulsion fracture: twisting of hand against resistance or hyperextension


2.&nbsp;Body fracture: direct trauma
==Management==
{{General Fracture Management}}


| Tenderness at dorsum of the wrist, distal to the ulnar styloid
===Specific Management===
| Short arm, sugar tong splint
*Based on fracture location (see individual fracture page for details)
|-
| Lunate
| FOOSH
| Tenderness at shallow indentation of the mid-dorsum of wrist, ulnar and distal to Lister tubercle
| Short arm, thumb spica splint
|-
| Trapezium
| Direct blow to thumb; force to wrist while dorsiflexed and radially deviated
| Painful thumb movement and weak pinch strength; snuffbox tenderness
| Short arm thumb spica splint
|-
| Pisiform
| Fall directed on hypothenar eminence
| Tender pisiform, prominent at the base of hypothenar eminence
| Short arm, volar splint in 30 degrees flexion and ulnar deviation
|-
| Hamate
| Interrupted swing of golf club, bat, or racquet
| Tenderness at hook of hamate, just distal and radial to the pisiform
| Short arm, volar wrist splint with 4th and 5th metacarpal joints in flexion
|-
| Capitate
| Forceful dorsiflexion of the hand with radial impact
| Tenderness over capitate just proximal to the third metacarpal
| Short arm, volar wrist splint
|-
| Trapezoid
|
| Tenderness over radial aspect of base of index metacarpal
| Short arm thumb spica splint
|}


== Imaging  ==
==See Also==
*See [[Wrist Bones]]  
*[[Fractures (main)]]
*Checklist
*[[Carpal dislocations]]
#Radial articular surface lies distal to the ulna
#Dorsal surface of the distal radius is smooth
#Waist of the scaphoid is intact
#Intercarpal joints are no more than 2mm wide; adjacent surfaces are parallel
#Capitate sits in the concavity of the lunate
#Palmar tilt of the radius is present
*Views
**PA
***Evaluate [[Media:Zone_of_Vulnerability.jpg|Zone of Vulnerability]]  
**Lateral
***Evaluate scapholunate angle (should be between 40-60deg)
**Oblique
**Other Views:
***PA with maximal ulnar deviation ("Scaphoid View")
****Scaphoid fx
***Carpal tunnel view
****Hamate hook fx
****Trapezium fx
****Pisiform Fx
***PA clenched fist view
****Consider for scapholunate instability (space &gt;2mm suggests ligamentous disruption)
***CT
****Trapezoid fx


== Disposition  ==
==References==
*Scaphoid Fx
<references/>
**Always refer to a hand surgeon b/c may lead to osteonecrosis if not recognized/treated
*Lunate Fx
**Always refer to a hand surgeon b/c may lead to osteonecrosis if not recognized/treated
*Triquetrum Fx
**Refer for displacment &gt;1mm
*Pisiform Fx
**Tend to do well with casting; refer for casting if unable to obtain in the ED
*Hamate Fx
**Refer for dislocation, pts who need to return to actvitiy ASAP
*Capitate Fx
**Always refer to a hand surgeon b/c may lead to osteonecrosis if not recognized/treated
*Trapezoid Fx
**Refer for comminution or dislocation
*Trapezium Fx
**Refer for displacement &gt;2mm, intraarticular fx w/ &gt;1mm incongruity, comminuted fx


== Source  ==
[[Category:Orthopedics]]
*UpToDate
*Accident &amp; Emergency Radiology
*Tintinalli
 
== See Also  ==
*[[Wrist Bones]]
 
[[Category:Ortho]]

Latest revision as of 22:12, 27 March 2024

Background

Carpal bones
Zone of Vulnerability
  • Scaphoid fractures account for 70% of all carpal fractures
  • Ulnar nerve damage associated with fractures of hamate or pisiform
  • 50% of pisiform fracture associated with injury to distal radius or other carpal bone
  • If bone fragment seen posterior to carpus on lateral, very likely triquetrum fracture

Fracture Types

Carpal fractures

AP view

Evaluation

Lateral view
  • Evaluate Zone of Vulnerability (see picture)

Management

General Fracture Management

Specific Management

  • Based on fracture location (see individual fracture page for details)

See Also

References

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