Carpal Bone Fractures
Section snippets
Hook fractures
The hook of the hamate protrudes off the hamate into the base of the hypothenar eminence and is palpable 2 cm distal and radial to the pisiform. The relatively thick layer of skin, palmar fibrofatty tissue, and palmaris brevis make palpation more difficult than that of the pisiform. There are multiple attachments to the hook of the hamate including the transverse carpal ligament radially, the pisohamate ligament ulnarly, and the flexor digiti minimi and opponens digiti muscles. The hamate marks
Triquetral fractures
The triquetrum is pyramid shaped. It articulates with the hamate distally, the triangular fibrocartilaginous complex proximally, and the lunate medially. Its palmar surface has an almost completely circular cartilaginous articulation with the pisiform. The triquetrum is well protected by ligamentous attachments on both the dorsal and volar side of the wrist. Triquetral fractures, however, make up the most common carpal bone fracture next to scaphoid fractures [26]. Triquetral fractures can
Pisiform fractures
The pisiform, like the patella, is a sesamoid bone enclosed in the sheath of the flexor carpi ulnaris tendon. It lies on the volar surface and articulates with the triquetrum. The pisiform is the last bone to ossify between ages 8 and 12 years. There may be multiple centers of ossification, giving it a fragmented appearance. This normal appearance must be distinguished from a fracture [32]. Acute pisiform fractures are reported as a source of ulnar-sided wrist pain [7]. If a fracture is
Capitate fractures
The capitate is the largest of the carpal bones and is well protected in the middle column of the wrist where it is surrounded by the other carpal bones and strong wrist ligaments. Fractures of the capitate are relatively rare. In one review, Rand and colleagues [36] found 11 capitate fractures in 978 carpal bone injuries for an incidence of 1.3%. The mechanism of injury of this fracture is debatable. It may involve a direct blow to the wrist, a fall with the wrist in dorsiflexion and ulnar
Lunate fractures
The lunate is shaped like a crescent. Its distal aspect is concave and articulates with the capitate; proximally it articulates with the lunate facet of the distal radius. In a normal situation, the lateral radiographic view shows the capitate, lunate, and distal radius collinear with the wrist in a neutral position. The lunate is integral in the flexion/extension arc and the radial/ulnar deviation arc at both the radiocarpal and midcarpal joints.
Fractures to the lunate are rare. Teisen and
Trapezium fractures
The trapezium forms a double-saddle articulation with the base of the thumb metacarpal allowing motion in two planes—both flexion/extension and abduction/adduction. The volar “beak” ligament from the metacarpal to the trapezium is a key structure in maintaining joint stability and resisting dorsal radial subluxation during key pinch. The trapezium body articulates with the carpal bones. The trapezial ridge is a volar structure that serves as a radial attachment for the transverse carpal
Trapezoid fractures
The trapezoid is tightly positioned between the base of the second metacarpal, capitate, scaphoid, and trapezium with strong intercarpal ligaments. It is wedge shaped, twice as wide dorsally as palmarly, and thereby forms the keystone of the carpal arch. It is the least commonly fractured carpal bone. Because of this position, the more commonly reported injuries include a dorsal dislocation [55]. Axially loading injuries leading to trapezoid fractures can occur [56]. Dislocations can be treated
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Cited by (31)
Isolated trapezoid fracture: four cases of a rare fracture on MRI
2020, Radiology Case ReportsCitation Excerpt :Trapezoid fractures are rarely seen due to the relative shelter of multiple strong ligamentous attachments, accounting for as little as 0.4% of carpal bone fractures [9]. Isolated fractures without additional traumatic fractures or dislocations are even more rare [4–8]. In the few described cases, the mechanisms have varied significantly and include punching [5,6], as in the first case, a direct blow to the dorsum of the wrist [7], hyperextension [8], and hyperflexion [9].
Carpal Fractures Other than Scaphoid in the Athlete
2020, Clinics in Sports MedicineCitation Excerpt :Shear forces from taut flexor tendons during power grip contribute to the fracture and displacement along with direct compression.16 Hamate body fractures occur with high-energy axial load to the fourth and fifth digits, and can occur as a carpometacarpal fracture-dislocation.17,35 In the athlete, these can occur with a direct fall causing an axial load at the fourth and fifth carpometacarpal joints.
Evaluation of grip strength in hook of hamate fractures treated with osteosynthesis. Is this surgical treatment necessary?
2019, Acta Orthopaedica et Traumatologica TurcicaCitation Excerpt :A high index of suspicion is required to correctly establish a diagnosis of hamate hook fracture after acute or chronic injuries over the hypothenar area of the hand, even when the radiographic study is negative. For this reason CT is the radiological modality of choice in the diagnosis of hamate hook fracture.1–3 MRI can rate the integrity of surrounding soft tissue but we do not consider it an essential test to diagnose this fracture.
Clinical case: surgical treatment for ulnar neuropathy due to pseudoarthrosis of the hook of the hamate
2017, Revista Andaluza de Medicina del DeporteCarpal Fractures Other than Scaphoid
2015, Clinics in Sports MedicineThe durability of the intrascaphoid compression of headless compression screws: In vitro study
2012, Journal of Hand Surgery