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