|
|
| (36 intermediate revisions by 6 users not shown) |
| Line 1: |
Line 1: |
| == 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. 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 >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 >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 >2mm, intraarticular fx w/ >1mm incongruity, comminuted fx
| |
|
| |
|
| == Source ==
| | [[Category:Orthopedics]] |
| *UpToDate
| |
| *Accident & Emergency Radiology
| |
| *Tintinalli
| |
| | |
| == See Also ==
| |
| *[[Wrist Bones]]
| |
| *[[Scaphoid Fracture]]
| |
| | |
| [[Category:Ortho]] | |
