Carpal fractures: Difference between revisions

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

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

Specific Management

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

References

Authors:

@@ Line 1: / Line 1: @@
-== Background  ==
+==Background==
 [[File:Carpal bones.png|thumb|Carpal bones]]
-[[Image:Wrist xr ap.jpg|thumb|AP view]]
+[[File:Zone_of_Vulnerability.jpg|thumb|Zone of Vulnerability]]
-[[Image:Wrist_-_Lateral.jpg|Lateral view]]
+*[[Scaphoid fracture|Scaphoid fractures]] account for 70% of all carpal fractures
-*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
+*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
-==Specific Fractures==
+==Fracture Types==
 {{Carpal fractures}}
-==Overview==
+==Evaluation==
+[[Image:Wrist_-_Lateral.jpg|thumb|Lateral view]]
+*Evaluate Zone of Vulnerability (see picture)
-{| width="300" border="1" cellpadding="1" cellspacing="1"
+==Management==
-|-
+{{General Fracture Management}}
-! scope="col" | Carpal Bone
-! 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
-|
-. Avulsion fracture: twisting of hand against resistance or hyperextension
-.&nbsp;Body fracture: direct trauma
+===Specific Management===
+*Based on fracture location (see individual fracture page for details)
-| Tenderness at dorsum of the wrist, distal to the ulnar styloid
+==See Also==
-| Short arm, sugar tong splint
+*[[Fractures (main)]]
-|-
+*[[Carpal dislocations]]
-| 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  ==
+==References==
-*See [[Wrist Bones]]
+<references/>
-*Evaluate [[Media:Zone_of_Vulnerability.jpg|Zone of Vulnerability]]
-== Source  ==
+[[Category:Orthopedics]]
-*UpToDate
-*Accident &amp; Emergency Radiology
-*Tintinalli
-== See Also  ==
-*[[Wrist Bones]]
-*[[Fracture (Main)]]
-[[Category:Ortho]]