Wrist & Carpal Fractures

Scaphoid Fracture

• Scaphoid is the common fractured carpal bone
• Fall on the palm of the outstretched hand
• Presents with pain, tenderness in the anatomical snuffbox

Scaphoid Fracture

• Blood supply comes from distal to proximal
  • Avascular necrosis (AVN) common with proximal 1/3 fracture
• Radiology:
  • AP and Lateral not enough
  • Need an special scaphoid view

Scaphoid Fracture

• Complications
  • Avascular necrosis (AVN):
    • Mainly proximal 1/3 fracture
  • Non-union:
    • In undiagnosed or undertreated scaphoid#
  • Wrist osteoarthritis
    • A result of non-union and AVN

narrowing+ sclerosis

Scaphoid Fracture - Treatment

• Not all fractures are apparent initially in image, If tenderness is present:

  • Treat by thumb Spica cast
  • Repeat x ray after 2 weeks

• Non / minimally displaced waist & distal fractures

  • Short arm thumb Spica
  • Extend to16 weeks depending on fracture location

• Displaced and proximal fractures

  • Internal fixation with special screw

Metacarpal Fractures

• Careful about rotational malalignment
  • Check rotation by flexing the fingers

Finger malrotation

• Undisplaced / or only one MC
• Treatment by cast / or splint

• Displaced / Rotated / Multiple
  • Treated by internal fixation (screws / plates / wires)

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Mallet Finger

• Avulsion injury of extensor tendons insertion to distal phalanx

• Mechanism of injury

  • Sudden forceful flexion (e.g. ball hits tip of finger)

• Clinical picture

  • Flexed distal IP joint
  • Loss of active extension of DIP joint

• Treatment

  • Mallet finger splint
  • Internal fixation if avulsed bone is large