Edited by Christina Liu and CJ Nessralla - 7/1/2021
Descriptors
Carpal fractures
Exam Pearls
Workup
Radiographs: PA/lateral/oblique XR of wrist (often inadequate to determine carpal fxs) Triquetrum: visible on PA view if transverse fractures
Other imaging: CT/MRI often needed to visualize fracture
Labs: NA
Other: NA
Management
Need for acute intervention: Yes, immobilization with or without reduction
Weight-bearing and range of motion: NWB and no ROM wrist (splinted)
Type of immobilization: AO short arm splint
Admission or discharge status: Discharge and follow up in 1-2 weeks in hand clinic. Repeat XR can reveal fracture a bit more than acute ED XR. Can also get CT/MRI at this point if not already completed in ED.
Anticoagulation: NA
Antibiotics: NA
Surgical Indications
Absolute: NA
Relative:
Lunate: displaced or angulated fractures
Triquetrum: displaced body fractures - pinning vs removal
Pisiform: displaced fragment - removal
Trapezium: CMC articular involvement, step off, comminution, displaced fractures
Trapezoid: displaced fractures involving CMC subluxation
Capitate: displaced fracture require reduction +/- pinning to prevent AVN
Hamate: subluxation of 4th/5th MC -> screw fixation or pinning, removal of hook of hamate fragments