Carpal Fractures (Excluding Scaphoid)

Abstract

Fractures of the carpal bones can present in isolation or as part of a more extensive ligamentous and osseous injury. When assessing a patient with a wrist injury, it is important to clinically examine the whole wrist and to look for associated injuries in every case of carpal fracture.

A high level of clinical suspicion is necessary for their diagnosis. Taking an accurate history of the injury, carrying out a clinical examination looking for the area of tenderness and obtaining appropriate radiographs and sectional imaging (CT or MRI) are required in order to make a decision on optimum management.

Questions and Answers

• Q1

• An athlete presents with dorsal ulnar-sided wrist pain after a forced flexion injury. Which bone is likely to be injured caused by a ligament avulsion?

• A

• The triquetrum —with avulsion of the dorsal extrinsic radiolunotriquetral ligament

• Q2

• An athlete falls onto the palm of their hand. They have localised pain, numbness of the little finger and tenderness on little finger flexion. What have they most likely done?

• A2

• A fracture to the hook of hamate . A period of rest and immobilisation may be considered, but often the hook becomes a painful non-union requiring excision.