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European Journal of Trauma and Emergency Surgery

Published in:

01-02-2016 | Review Article

Uncommon carpal fractures

Authors: T. Pan, T. T. Lögters, J. Windolf, R. Kaufmann

Published in: European Journal of Trauma and Emergency Surgery | Issue 1/2016

Abstract

Fractures of the hand are frequently encountered with injuries to the phalanges and metacarpals comprising the vast majority. Fractures of the carpal bones excluding the scaphoid, however, are fairly uncommon. Despite the rarity of fractures of the remaining seven carpal bones, they can cause a disproportionate amount of morbidity from missed diagnosis due to their subtlety as well as their frequent association with significant ligamentous disruption or even other carpal bone fractures. Delayed diagnosis can result in inadequate fracture care, which places the wrist at risk of disabling sequelae. This review focuses on the current concepts of pathophysiology, diagnosis, and treatment of carpal fractures other than the scaphoid.

van Onselen EB, Karim RB, Hage JJ, Ritt MJ. Prevalence and distribution of hand fractures. J Hand Surg Br. 2003;28(5):491–5. doi:10.1016/S0266-7681(03)00103-7.CrossRefPubMed

Hove LM. Fractures of the hand. Distribution and relative incidence. Scand J Plast Reconstr Surg Hand Surg. 1993;27(4):317–9.PubMed

Papp S. Carpal bone fractures. Hand Clin. 2010;26(1):119–27. doi:10.1016/j.hcl.2009.08.014.CrossRefPubMed

Komura S, Yokoi T, Nonomura H, Tanahashi H, Satake T, Watanabe N. Incidence and characteristics of carpal fractures occurring concurrently with distal radius fractures. J Hand Surg Am. 2012;37(3):469–76. doi:10.1016/j.jhsa.2011.11.011.CrossRefPubMed

Kaewlai R, Avery LL, Asrani AV, Abujudeh HH, Sacknoff R, Novelline RA. Multidetector CT of carpal injuries: anatomy, fractures, and fracture-dislocations. Radiographics. 2008;28(6):1771–84. doi:10.1148/rg.286085511.CrossRefPubMed

Hocker K, Menschik A. Chip fractures of the triquetrum. Mechanism, classification and results. J Hand Surg Br. 1994;19(5):584–8.CrossRefPubMed

Panagis JS, Gelberman RH, Taleisnik J, Baumgaertner M. The arterial anatomy of the human carpus. Part II: the intraosseous vascularity. J Hand Surg Am. 1983;8(4):375–82.CrossRefPubMed

Gelberman RH, Gross MS. The vascularity of the wrist. Identification of arterial patterns at risk. Clin Orthop Relat Res. 1986;202:40–9.PubMed

Sennwald G, Segmuller G, Egli A. The late reconstruction of the ligament of the metacarpo-phalangeal joint of the thumb. Ann Chir Main. 1987;6(1):15–24.CrossRefPubMed

10.

Hey HW, Chong AK, Murphy D. Prevalence of carpal fracture in Singapore. J Hand Surg Am. 2011;36(2):278–83. doi:10.1016/j.jhsa.2010.11.009.CrossRefPubMed

11.

Smith DK, Murray PM. Avulsion fractures of the volar aspect of triquetral bone of the wrist: a subtle sign of carpal ligament injury. AJR Am J Roentgenol. 1996;166(3):609–14. doi:10.2214/ajr.166.3.8623636.CrossRefPubMed

12.

Shah MA, Viegas SF. Fractures of the carpal bones excluding the scaphoid. J Am Soc Surg Hand. 2002;2(3):129–40.CrossRef

13.

Marchessault J, Conti M, Baratz ME. Carpal fractures in athletes excluding the scaphoid. Hand Clin. 2009;25(3):371–88. doi:10.1016/j.hcl.2009.05.013.CrossRefPubMed

14.

Garcia-Elias M. Dorsal fractures of the triquetrum–avulsion or compression fractures? J Hand Surg Am. 1987;12(2):266–8.CrossRefPubMed

15.

Lee SJ, Rathod CM, Park KW, Hwang JH. Persistent ulnar-sided wrist pain after treatment of triquetral dorsal chip fracture: six cases related to triangular fibrocartilage complex injury. Arch Orthop Trauma Surg. 2012;132(5):671–6. doi:10.1007/s00402-011-1416-0.CrossRefPubMed

16.

De Beer JD, Hudson DA. Fractures of the triquetrum. J Hand Surg Br. 1987;12(1):52–3.CrossRefPubMed

17.

Aiki H, Wada T, Yamashita T. Pisotriquetral arthrosis after triquetral malunion: a case report. J Hand Surg Am. 2006;31(7):1157–9. doi:10.1016/j.jhsa.2006.05.006.CrossRefPubMed

18.

Suzuki T, Nakatsuchi Y, Tateiwa Y, Tsukada A, Yotsumoto N. Osteochondral fracture of the triquetrum: a case report. J Hand Surg Am. 2002;27(1):98–100. doi:10.1053/jhsu.2002.28944.CrossRefPubMed

19.

Garcia-Elias M, Henriquez-Lluch A, Rossignani P, Fernandez de Retana P, Orovio de Elizaga J. Bennett’s fracture combined with fracture of the trapezium. A report of three cases. J Hand Surg Br. 1993;18(4):523–6.CrossRefPubMed

20.

Palmer AK. Trapezial ridge fractures. J Hand Surg Am. 1981;6(6):561–4.CrossRefPubMed

21.

Garneti N, Tuson CE. Sagittally split fracture of trapezium associated with subluxated carpo-metacarpal joint of thumb. Injury. 2004;35(11):1172–5. doi:10.1016/j.injury.2003.09.004.CrossRefPubMed

22.

Cordrey LJ, Ferrer-Torells M. Management of fractures of the greater multangular. Report of five cases. J Bone Joint Surg Am. 1960;42-A:1111–8.PubMed

23.

McGuigan FX, Culp RW. Surgical treatment of intra-articular fractures of the trapezium. J Hand Surg Am. 2002;27(4):697–703. doi:10.1053/jhsu.2002.33705.CrossRefPubMed

24.

McClain EJ, Boyes JH. Missed fractures of the greater multangular. J Bone Joint Surg Am. 1966;48(8):1525–8.PubMed

25.

Walker JL, Greene TL, Lunseth PA. Fractures of the body of the trapezium. J Orthop Trauma. 1988;2(1):22–8.CrossRefPubMed

26.

Vigler M, Aviles A, Lee SK. Carpal fractures excluding the scaphoid. Hand Clin. 2006;22(4):501–16 (abstract vii). doi:10.1016/j.hcl.2006.07.007.CrossRefPubMed

27.

Gruson KI, Kaplan KM, Paksima N. Isolated trapezoid fractures: a case report with compilation of the literature. Bull NYU Hosp Joint Dis. 2008;66(1):57–60.

28.

Botte MJ, von Schroeder HP, Gellman H, Cohen MS. Fracture of the trapezial ridge. Clin Orthop Relat Res. 1992;276:202–5.PubMed

29.

Foster RJ, Hastings H 2nd. Treatment of Bennett, Rolando, and vertical intraarticular trapezial fractures. Clin Orthop Relat Res. 1987;214:121–9.PubMed

30.

Inston N, Pimpalnerkar AL, Arafa MA. Isolated fracture of the trapezium: an easily missed injury. Injury. 1997;28(7):485–8. doi:10.4076/1757-1626-2-8304.CrossRefPubMed

31.

Tolat AR, Jones MW. Carpometacarpal dislocation of the thumb associated with fracture of the trapezium. Injury. 1990;21(6):411–2.CrossRefPubMed

32.

Conway WF, Gilula LA, Manske PR, Kriegshauser LA, Rholl KS, Resnik C. Translunate, palmar perilunate fracture-subluxation of the wrist. J Hand Surg Am. 1989;14(4):635–9. doi:10.1016/0363-5023(89)90181-0.CrossRefPubMed

33.

Johnson RP. The acutely injured wrist and its residuals. Clin Orthop Relat Res. 1980;149:33–44.PubMed

34.

Bain GI, McLean JM, Turner PC, Sood A, Pourgiezis N. Translunate fracture with associated perilunate injury: 3 case reports with introduction of the translunate arc concept. J Hand Surg Am. 2008;33(10):1770–6. doi:10.1016/j.jhsa.2008.06.017.CrossRefPubMed

35.

Teisen H, Hjarbaek J. Classification of fresh fractures of the lunate. J Hand Surg Br. 1988;13(4):458–62. doi:10.1016/0266-7681(88)90180-5.CrossRefPubMed

36.

Cetti R, Christensen SE, Reuther K. Fracture of the lunate bone. Hand. 1982;14(1):80–4.CrossRefPubMed

37.

Failla JM, Amadio PC. Recognition and treatment of uncommon carpal fractures. Hand Clin. 1988;4(3):469–76.PubMed

38.

Amaravati RS, Saji MJ, Rajagopal HP. Greater arc injury of the wrist with fractured lunate bone: a case report. J Orthop Surg (Hong Kong). 2005;13(3):310–3.

39.

Teisen H, Hjarbaek J, Jensen EK. Follow-up investigation of fresh lunate bone fracture. Handchir Mikrochir Plast Chir. 1990;22(1):20–2.PubMed

40.

Freeland AE, Ahmad N. Oblique shear fractures of the lunate. Orthopedics. 2003;26(8):805–8.PubMed

41.

Beckenbaugh RD, Shives TC, Dobyns JH, Linscheid RL. Kienbock’s disease: the natural history of Kienbock’s disease and consideration of lunate fractures. Clin Orthop Relat Res. 1980;149:98–106.PubMed

42.

Rand JA, Linscheid RL, Dobyns JH. Capitate fractures: a long-term follow-up. Clin Orthop Relat Res. 1982;165:209–16.PubMed

43.

Sabat D, Arora S, Dhal A. Isolated capitate fracture with dorsal dislocation of proximal pole: a case report. Hand (N Y). 2011;6(3):333–6. doi:10.1007/s11552-011-9337-5.CrossRef

44.

Gelberman RH, Panagis JS, Taleisnik J, Baumgaertner M. The arterial anatomy of the human carpus. Part I: the extraosseous vascularity. J Hand Surg Am. 1983;8(4):367–75.CrossRefPubMed

45.

Garcia-Elias M, Bishop AT, Dobyns JH, Cooney WP, Linscheid RL. Transcarpal carpometacarpal dislocations, excluding the thumb. J Hand Surg Am. 1990;15(4):531–40.CrossRefPubMed

46.

Vance RM, Gelberman RH, Evans EF. Scaphocapitate fractures. Patterns of dislocation, mechanisms of injury, and preliminary results of treatment. J Bone Joint Surg Am. 1980;62(2):271–6.PubMed

47.

Monahan PR, Galasko CS. The scapho-capitate fracture syndrome. A mechanism of injury. J Bone Joint Surg Br. 1972;54(1):122–4.PubMed

48.

Kim YS, Lee HM, Kim JP. The scaphocapitate fracture syndrome: a case report and literature analysis. Eur J Orthop Surg Traumatol. 2013;23(Suppl 2):S207–12. doi:10.1007/s00590-013-1182-5.CrossRefPubMed

49.

Yoshihara M, Sakai A, Toba N, Okimoto N, Shimokobe T, Nakamura T. Nonunion of the isolated capitate waist fracture. J Orthop Sci. 2002;7(5):578–80. doi:10.1007/s007760200103.CrossRefPubMed

50.

Peters SJ, Degreef I, De Smet L. Avascular necrosis of the capitate: report of six cases and review of the literature. J Hand Surg Eur. 2014;40(5):520–5. doi:10.1177/1753193414524876.CrossRef

51.

O’Shea K, Weiland AJ. Fractures of the hamate and pisiform bones. Hand Clin. 2012;28(3):287–300. doi:10.1016/j.hcl.2012.05.010.CrossRefPubMed

52.

Watson HK, Rogers WD. Nonunion of the hook of the hamate: an argument for bone grafting the nonunion. J Hand Surg Am. 1989;14(3):486–90.CrossRefPubMed

53.

Failla JM. Hook of hamate vascularity: vulnerability to osteonecrosis and nonunion. J Hand Surg Am. 1993;18(6):1075–9. doi:10.1016/0363-5023(93)90405-R.CrossRefPubMed

54.

Milch H. Fracture of the hamate bone. J Bone Joint Surg Am. 1934;16(2):459–62.

55.

Cain JE Jr, Shepler TR, Wilson MR. Hamatometacarpal fracture-dislocation: classification and treatment. J Hand Surg Am. 1987;12(5 Pt 1):762–7.CrossRefPubMed

56.

Ebraheim NA, Skie MC, Savolaine ER, Jackson WT. Coronal fracture of the body of the hamate. J Trauma. 1995;38(2):169–74.CrossRefPubMed

57.

Wolfe SW, Pederson WC, Hotchkiss RN, Kozin SH. Green’s operative hand surgery. 6th ed. Churchill Livingstone: London; 2010.

58.

Stark HH, Jobe FW, Boyes JH, Ashworth CR. Fracture of the hook of the hamate in athletes. J Bone Joint Surg Am. 1977;59(5):575–82.PubMed

59.

Stark HH, Chao EK, Zemel NP, Rickard TA, Ashworth CR. Fracture of the hook of the hamate. J Bone Joint Surg Am. 1989;71(8):1202–7.PubMed

60.

Wright TW, Moser MW, Sahajpal DT. Hook of hamate pull test. J Hand Surg Am. 2010;35(11):1887–9. doi:10.1016/j.jhsa.2010.08.024.CrossRefPubMed

61.

Shea JD, McClain EJ. Ulnar-nerve compression syndromes at and below the wrist. J Bone Joint Surg Am. 1969;51(6):1095–103.PubMed

62.

Gillespy T 3rd, Stork JJ, Dell PC. Dorsal fracture of the hamate: distinctive radiographic appearance. AJR Am J Roentgenol. 1988;151(2):351–3. doi:10.2214/ajr.151.2.351.CrossRefPubMed

63.

Hart VI, Gaynor V. Roentgenographic study of the carpal canal. J Bone Joint Surg Am. 1941;23(2):382–3.

64.

Andress MR, Peckar VG. Fracture of the hook of the hamate. Br J Radiol. 1970;43(506):141–3.CrossRefPubMed

65.

Andresen R, Radmer S, Sparmann M, Bogusch G, Banzer D. Imaging of hamate bone fractures in conventional X-rays and high-resolution computed tomography. An in vitro study. Invest Radiol. 1999;34(1):46–50.CrossRefPubMed

66.

Kato H, Nakamura R, Horii E, Nakao E, Yajima H. Diagnostic imaging for fracture of the hook of the hamate. Hand Surg. 2000;5(1):19–24. doi:10.1142/S0218810400000090.CrossRefPubMed

67.

Egawa M, Asai T. Fracture of the hook of the hamate: report of six cases and the suitability of computerized tomography. J Hand Surg Am. 1983;8(4):393–8.CrossRefPubMed

68.

Garcia-Elias M, Dobyns JH, Cooney WP 3rd, Linscheid RL. Traumatic axial dislocations of the carpus. J Hand Surg Am. 1989;14(3):446–57.CrossRefPubMed

69.

Whalen JL, Bishop AT, Linscheid RL. Nonoperative treatment of acute hamate hook fractures. J Hand Surg Am. 1992;17(3):507–11.CrossRefPubMed

70.

Foucher G, Schuind F, Merle M, Brunelli F. Fractures of the hook of the hamate. J Hand Surg Br. 1985;10(2):205–10.CrossRefPubMed

71.

David TS, Zemel NP, Mathews PV. Symptomatic, partial union of the hook of the hamate fracture in athletes. Am J Sports Med. 2003;31(1):106–11.PubMed

72.

Yamazaki H, Kato H, Nakatsuchi Y, Murakami N, Hata Y. Closed rupture of the flexor tendons of the little finger secondary to non-union of fractures of the hook of the hamate. J Hand Surg Br. 2006;31(3):337–41. doi:10.1016/J.JHSB.2005.12.015.CrossRefPubMed

73.

Bishop AT, Beckenbaugh RD. Fracture of the hamate hook. J Hand Surg Am. 1988;13(1):135–9. doi:10.1016/0363-5023(88)90217-1.CrossRefPubMed

74.

Scheufler O, Andresen R, Radmer S, Erdmann D, Exner K, Germann G. Hook of hamate fractures: critical evaluation of different therapeutic procedures. Plast Reconstr Surg. 2005;115(2):488–97. doi:10.1097/01.PRS.0000149480.25248.20.CrossRefPubMed

75.

Demirkan F, Calandruccio JH, Diangelo D. Biomechanical evaluation of flexor tendon function after hamate hook excision. J Hand Surg Am. 2003;28(1):138–43. doi:10.1053/jhsu.2003.50005.CrossRefPubMed

76.

Devers BN, Douglas KC, Naik RD, Lee DH, Watson JT, Weikert DR. Outcomes of hook of hamate fracture excision in high-level amateur athletes. J Hand Surg Am. 2013;38(1):72–6. doi:10.1016/j.jhsa.2012.10.011.CrossRefPubMed

77.

Milek MA, Boulas HJ. Flexor tendon ruptures secondary to hamate hook fractures. J Hand Surg Am. 1990;15(5):740–4.CrossRefPubMed

78.

Smith P 3rd, Wright TW, Wallace PF, Dell PC. Excision of the hook of the hamate: a retrospective survey and review of the literature. J Hand Surg Am. 1988;13(4):612–5.CrossRefPubMed

79.

Burnett SE. Hamate-pisiform coalition: morphology, clinical significance, and a simplified classification scheme for carpal coalition. Clin Anat. 2011;24(2):188–96. doi:10.1002/ca.21086.CrossRefPubMed

80.

Jacobs LG. Isolated fracture of the pisiform bone; a case report. Radiology. 1948;50(4):529–31. doi:10.1148/50.4.529.CrossRefPubMed

81.

Vasilas A, Grieco RV, Bartone NF. Roentgen aspects of injuries to the pisiform bone and pisotriquetral joint. J Bone Joint Surg Am. 1960;42(8):1317–28.

82.

Immermann EW. Dislocation of the pisiform. J Bone Joint Surg Am. 1948;30A(2):489-92.PubMed

83.

Muniz AE. Unusual wrist pain: pisiform dislocation and fracture. Am J Emerg Med. 1999;17(1):78–9. doi:10.1016/S0735-6757(99)90024-4.CrossRefPubMed

84.

Rayan GM, Jameson BH, Chung KW. The pisotriquetral joint: anatomic, biomechanical, and radiographic analysis. J Hand Surg Am. 2005;30(3):596–602. doi:10.1016/j.jhsa.2004.12.015.CrossRefPubMed

85.

Fleege MA, Jebson PJ, Renfrew DL, Steyers CM Jr, el-Khoury GY. Pisiform fractures. Skeletal Radiol. 1991;20(3):169–72.CrossRefPubMed

86.

Campion H, Goad A, Rayan G, Porembski M. Pisiform excision for pisotriquetral instability and arthritis. J Hand Surg Am. 2014;39(7):1251–7. doi:10.1016/j.jhsa.2014.02.037.CrossRefPubMed

87.

Carroll RE, Coyle MP Jr. Dysfunction of the pisotriquetral joint: treatment by excision of the pisiform. J Hand Surg Am. 1985;10(5):703–7.CrossRefPubMed

88.

van Eijzeren J, Karthaus RP. The effect of pisiform excision on wrist function. J Hand Surg Am. 2014;39(7):1258–63. doi:10.1016/j.jhsa.2014.04.019.CrossRefPubMed

89.

Matsunaga D, Uchiyama S, Nakagawa H, Toriumi H, Kamimura M, Miyasaka T. Lower ulnar nerve palsy related to fracture of the pisiform bone in patients with multiple injuries. J Trauma. 2002;53(2):364–8.CrossRefPubMed

90.

Collins ED, Gharbaoui I. Imaging and anatomic study of the pisiform bone/ulnar nerve relationship-evaluation of the preferred surgical approach for the excision of the pisiform bone. Tech Hand Up Extrem Surg. 2010;14(3):150–4. doi:10.1097/BTH.0b013e3181ccb7c3.PubMed

91.

Kain N, Heras-Palou C. Trapezoid fractures: report of 11 cases. J Hand Surg Am. 2012;37(6):1159–62. doi:10.1016/j.jhsa.2012.02.046.CrossRefPubMed

92.

Mehara AK, Bhan S. Rotatory dislocation of the second carpometacarpal joint: case report. J Trauma. 1993;34(3):464–6.CrossRefPubMed

Title: Uncommon carpal fractures
Authors: T. Pan
T. T. Lögters
J. Windolf
R. Kaufmann
Publication date: 01-02-2016
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Trauma and Emergency Surgery / Issue 1/2016
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-015-0618-5

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Uncommon carpal fractures

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