Carpal fractures

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

• Scaphoid fracture
• Lunate fracture
• Triquetrum fracture
• Pisiform fracture
• Trapezium fracture
• Trapezoid fracture
• Capitate fracture
• Hamate fracture

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)

See Also

• Fractures (main)
• Carpal dislocations