Nonscaphoid carpal injuries - Incidence and associated injuries

Abstract

Aims: Nonscaphoid fractures comprise approximately 40% of all carpal fractures. But the exact incidence of these rare injuries is still not clear. Missed or late diagnosis can lead to serious ligamentous disruption and permanent wrist dysfunction.

Methods: A retrospective analysis of wrist X-rays and CT scans were carried out for a period of 3 years. Incidence and associated injuries from this study was compared with literature. A total of 33 patients were included in our study. Both wrist X-rays and CT scans were reviewed individually by two authors. DASH scores were recorded for each patient.

Results: There were 26 male and 7 female patients. Out of 33 patients 13 (35%) were Triquetral fractures, 10 (27%) were Hamate fractures, 5 (14%) were Capitate fractures, 4 (11%) were Lunate fractures, 3 (8%) were Trapezium fractures and 2 (5%) were Pisiform fractures. There were no Trapezoid fractures in our study.

Conclusion: Incidence of nonscaphoid carpal fractures in our study is considerably higher when compared to literature. We propose that high index of suspicion should always be borne in mind when dealing with carpal fractures and detailed examination of wrist should be conducted even when X-rays does not show any obvious bony injuries. CT scans and other specialized images should be judiciously used in areas of suspicion for early diagnosis, to initiate immediate treatment, for early mobilisation and good functional recovery.

Keywords: Carpal injuries; Incidence; Nonscaphoid injuries.

Fig. 1

X-ray showing transcaphoid transcapitate transtriquetral fracture with perilunate dislocation.

Fig. 2

Triquetral fracture – X-ray, T2 weighted and T1 weighted MRI.

Fig. 3

Hamate fracture with fracture dislocation of 4th and 5th metacarpal base.

Fig. 4

CT-scan showing Hook of Hamate fracture.

Fig. 5

CT-scan showing Lunate fracture.