Carpal fractures

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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

  • Acute pain management
  • Open fractures require immediate IV antibiotics and urgent surgical washout
  • Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention
  • Consider risk for compartment syndrome
  • If any limitation to range of motion, orthopedics will often perform elbow arthrocentesis to remove hemarthrosis which is often present
    • The purpose of this is to see whether range of motion is restored after aspiration since if it is not, this may be an indication for surgery
    • This is generally not necessary to perform in the ED but can be done for patient comfort

Specific Management

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

See Also

Video

References