Fractures of the Carpus

15d – Fractures of the Carpus
Fractures of scaphoid bone:
 * Due to direct dorsiflexion force to the hand

Classification:
 * Scaphoid tubercle fracture (distal end) – extra articular fracture heals well
 * Proximal end fracture – poor blood supply – heal nonunion or avascular necrosis
 * Fracture of the body – most often, according to Russ, it’s divided into:
 * 1) Horizontal
 * 2) transverse
 * 3) vertical

clinical picture & diagnosis:
 * clinically evident pain on the foveola radialis and the pressure in the long axis of the thumb
 * X-Ray AP, wrist in dorsiflexion and in ulnar deviation (navicular quartet)
 * The fracture may not be evident immediately after the accident (if you insist on a negative finding further pain (diagnosed as distorse wrist), repeat X-ray even after 2-3 weeks of immobilization)
 * The most reliable diagnosis is CT

Treatment:


 * Conservative:
 * 1) For nondislocated fracture, immobile with plaster from elbow to metacarpal bone with wrist in ulnar deviation, and abduction thumb for at least 6 weeks
 * 2) Then X-ray – if not healed, extend the immobilization to 8-12 weeks


 * Operaton:
 * 1) If fracture of proximal and central part
 * 2) Use osteosynthesis Herbert screw

Complication:


 * Avascular necrosis of the fragment


 * Nonunion – surgically treated by:
 * 1) osteosynthesis compression,
 * 2) cortico-cancellous graft from iliac crest
 * 3) palliative resection of processus of styloid radii


 * Radiocarpal joint arthrosis