Carpal Fractures
Basics
Description
Description
- Carpal bones make up the eight bones of the wrist between the radius and ulna proximally and the metacarpals distally:
- Proximal carpal row: Scaphoid, lunate, triquetrum, pisiform
- Distal row: Trapezium, trapezoid, capitate, hamate
- Most commonly injured region of upper extremity:
- Most commonly fractured carpals are the scaphoid (68%) and triquetrum (18%)
- Fractures of the trapezium, hamate, capitate, and trapezoid follow in prevalence (2–4%)
- Carpal bone fractures commonly occur with other wrist injuries:
- 90% of scaphoid fractures are isolated, while a significant proportion of all other carpal bone fractures involve multiple carpal bones
- Capitate fractures along with scaphoid (scaphocapitate syndrome) sometimes occur with perilunate dislocations
- Lunate and triquetrum fractures are also associated with perilunate dislocations
- Hamate fractures are associated with injuries to fourth and fifth CMC and metacarpals concurrent with distal radius fractures
Etiology
Etiology
- Fall on outstretched hand (FOOSH) with a hyperextended or hyperflexed wrist
- Mechanisms of injury for all fractures commonly include FOOSH
- Scaphoid fracture:
- FOOSH with fall onto extended and radially deviated wrist
- Lunate fracture:
- Typically fall onto extended wrist
- Triquetrum fracture:
- Divided into avulsion (93%) fractures and body fractures
- Hyperextension → dorsal avulsion fracture
- Hyperflexion → volar avulsion fracture
- Body fracture: Typically results from direct blow and high-energy forces
- 12–25% a/w perilunate dislocation
- Trapezium fracture:
- Typically fall onto extended wrist
- Capitate fracture:
- Fall onto clenched fist
- Trapeziod fracture:
- Axial loading of second metacarpal
- Pisiform fracture:
- Direct impact against hard surface
- Hook of hamate fracture:
- Forceful swing of a racquet or club
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Citation
Schaider, Jeffrey J., et al., editors. "Carpal Fractures." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307601/all/Carpal_Fractures.
Carpal Fractures. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307601/all/Carpal_Fractures. Accessed October 15, 2024.
Carpal Fractures. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307601/all/Carpal_Fractures
Carpal Fractures [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 October 15]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307601/all/Carpal_Fractures.
* Article titles in AMA citation format should be in sentence-case
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