Arch Hand Microsurg.  2025 Mar;30(1):2-14. 10.12790/ahm.24.0060.

Management of carpal bone fractures other than the scaphoid: a narrative review

• Oh MJ
• Oh CH
• Kang JW

• KMID: 2565462
• DOI: http://doi.org/10.12790/ahm.24.0060

Abstract

While scaphoid injuries are the most common carpal bone injuries, injuries to other carpal bones also occur frequently, accounting for about 40% of all carpal bone injuries. These non-scaphoid injuries are often complex, typically resulting from high-energy trauma and involving damage to two or more carpal bones or surrounding soft tissues. The carpus is a complex joint with eight carpal bones, making an accurate initial diagnosis challenging in many cases. A missed diagnosis or delayed treatment can lead to complications such as malunion, nonunion, avascular necrosis, and carpal instability. These complications can result in arthritis, neurovascular compression, and tendon rupture, causing chronic pain and functional impairment of the wrist joint. Therefore, careful attention to diagnosis and treatment is essential at the time of injury.

Keyword

Wrist; Carpus; Fracture; Diagnosis; Treatment; 손목; 수근골; 골절; 진단; 치료

Figure

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  Fig. 1. (A) Volar carpal ligaments. (B) Dorsal carpal ligaments (I, 1st metacarpal bone; V, 5th metacarpal bone; R, radius; U, ulna; S, scaphoid; L, lunate; T, triquetrum; P, pisiform; Tm, trapezium; Td, trapezoid; C, capitate; H, hamate; LT, Lister’s tubercle). Reprinted from Geert et al. [7] with the permission of Elsevier.

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  Fig. 2. Dorsal cortical fracture of the triquetrum. (A) Lateral view of simple radiography, (B) “pooping duck” sign, and (C) pronation oblique view of simple radiography. White arrows indicate fracture site.

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  Fig. 3. Hamate body fracture combined with fourth and fifth carpometacarpal dislocation. (A) Lateral simple radiography, (B) sagittal computed tomography, and (C) postoperative radiography. White arrows indicate the fracture site.

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  Fig. 4. A patient (A) with fifth finger flexion disability due to (B) fifth flexor digitorum profundus tendon rupture and flexor digitorum superficialis tendon attrition by a nonunited hook of a hamate fracture (red arrow, damaged flexor tendon).

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  Fig. 5. Hook of a hamate fracture. (A) Simple radiography (carpal tunnel view) and (B) axial computed tomography. White arrows indicate the fracture site.

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  Fig. 6. Axial computed tomography image of a trapezial ridge fracture. White arrows indicate fracture site. Adapted from Jokuszies et al. [35] according to the Creative Commons License.

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  Fig. 7. Pisiform fracture. (A) Simple radiography (carpal tunnel view) and (B) axial computed tomography. White arrows indicate the fracture site.

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  Fig. 8. Transscaphoid-transscapitate-transtriquetral perilunate injury. (A) Simple radiography and (B) coronal computed tomography.

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  Fig. 9. Sagittal computed tomography image of scaphocapitate syndrome. White arrows indicate the fracture site.

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  Fig. 10. Lunate body fracture with comminuted fragment and potential carpal instability. (A) Supination oblique view of simple radiography. (B) Sagittal computed tomography. Axial (C) and sagittal (D) magnetic resonance imaging. (E) Postoperative simple radiography after open reduction and internal fixation with a headless compression screw and suture anchor. White arrows indicate the fracture site and yellow arrows indicate the key fragment attached to the scapholunate, lunotriquetral, and radioscaphocapitate ligament.

Reference

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