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Approximately 15% to 41% carpal fractures occur in nonscaphoid carpal bones, and often occur as an avulsion, as part of a peri-lunate pattern of injury, or a direct blow/axial load.
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Triquetral fractures are the most common nonscaphoid carpal fractures, accounting for 4% to 29% of all carpal fractures.
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In treating athletes, the hand surgeon must determine whether further injury is risked or if early return can be accomplished safely.
Carpal Fractures Other than Scaphoid in the Athlete
Section snippets
Key points
Carpal fractures other than scaphoid occur at lower rates
Triquetral fractures
Triquetral fractures are the second most common carpal fracture following scaphoid fractures. They account for 4% to 29% of all carpal fractures.3, 4, 5, 6, 7 Three primary patterns are noted: dorsal cortical or chip fractures, triquetral body fractures, and palmar cortical fractures.
Trapezium fractures
Trapezium fractures make up approximately 1% to 5% of carpal bone fractures.23, 24, 25, 26 They commonly occur with fractures of other bones, often with the distal radius or first metacarpal.24,26,27 Isolated fractures are rare. Fractures of the trapezium involve either the body or the ridge.
Hamate fractures
Hamate fractures make up approximately 2% of all carpal fractures.3,33,34 The unique anatomy of the hamate hook places the bone at risk, particularly if the palm is struck. The hook is the origin for the flexor digiti minimi muscles, opponens digiti minimi muscles, hypothenar muscles, pisohamate ligaments, and distal attachment of the transverse carpal ligament. It is the radial border of Guyon’s canal and the ulnar border of the carpal tunnel.16 Fractures of the hamate are classified as being
Capitate fractures
Capitate fractures make up 1% to 2% of all carpal fractures.3,57 The capitate is centered within the carpus and typically well protected from injury. The capitate articulates with the scaphoid and lunate proximally and is well attached to the long finger metacarpal distally forming the central column of the hand and wrist. Capitate fractures can occur as part of a greater arc perilunate fracture-dislocation, although they may still occur in isolation.58 The most common pattern for these remains
Pisiform fractures
Fractures of the pisiform account for 1% to 2% of carpal fractures.52,67 The pisiform is a prominent sesamoid bone within the flexor carpi ulnaris (FCU) tendon at the base of the hypothenar eminence. It also serves as an attachment point for the pisohamate, pisotriquetral, and transverse carpal ligaments, as well as the abductor digiti minimi muscle. About half of pisiform fractures are associated with other carpal injuries.13 These fractures may be categorized as transverse, parasagittal, or
Trapezoid fractures
Trapezoid fractures make up less than 1% of all carpal fractures.3,52 It is well surrounded and protected by the trapezium, scaphoid, capitate, and index metacarpal. Isolated fractures are extremely rare. The mechanism of injury is high-energy trauma, either an axial load or bending mechanism. This may be in combination with a fracture-dislocation of the index metacarpal.
The trapezoid is keystone shaped and has a dorsal surface twice as wide as the volar surface. The volar ligament are strong
Lunate fractures
Acute traumatic lunate fractures make up about 1% of all carpal fractures75 (Fig. 12). The lunate is well enclosed in the lunate fossa of the radius, and isolated acute fractures are rare. The challenge diagnosing an acute lunate fracture is whether it is truly acute or a pathologic fracture in the setting of Kienböck disease. The proposed mechanism of injury for a lunate fracture is compression of the lunate between the distal radius and capitate. A direct blow to the lunate with a ball has
Summary
Although carpal fractures of bones other than the scaphoid occur at a much lower rate than scaphoid fractures, they remain an important diagnosis in athletes as well as nonathletes. The close relationship between the carpus, the intrinsic and extrinsic wrist ligaments, and wrist kinematics forces the physician to be thorough in the history, clinical examination, and to be attentive in interpreting imaging for carpal malalignment. Carpal malalignment should be addressed with reduction and
Disclosure
The authors have nothing to disclose.
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