Carpal fractures: Difference between revisions
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*See [[Wrist Bones]] | *See [[Wrist Bones]] | ||
*Evaluate [[Media:Zone_of_Vulnerability.jpg|Zone of Vulnerability]] | *Evaluate [[Media:Zone_of_Vulnerability.jpg|Zone of Vulnerability]] | ||
== Source == | == Source == |
Revision as of 23:54, 7 February 2012
Background
- Scaphoid fractures account for 70% of all carpal fractures
- Ulnar nerve damage associated with fractures of hamate or pisiform
- 50% of pisiform fx associated with injury to distal radius or other carpal bone
- If bone fragment seen posterior to carpus on lateral, very likely triquetrum fx
Specific Fractures
- Scaphoid Fracture
- Triquetrum Fracture
- Lunate Fracture
- Trapezium Fracture
- Pisiform Fracture
- Hamate Fracture
- Capitate Fracture
- Trapezoid Fracture
Overview
Carpal Bone | Mechanism of Injury | Examination | ED Management |
---|---|---|---|
Scaphoid | FOOSH | Snuffbox tenderness; 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. Body fracture: direct trauma |
Tenderness at dorsum of the wrist, distal to the ulnar styloid | Short arm, sugar tong splint |
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 Wrist Bones
- Evaluate Zone of Vulnerability
Source
- UpToDate
- Accident & Emergency Radiology
- Tintinalli