Hand Fractures by Sex

Table 8.1 Sex distribution of 8913 patients with hand fractures

Hand Fractures by Fracture Side

Table 8.2 Fracture side distribution of 8913 patients with hand fractures

Hand Fractures by Age Group

Hand Fractures by Fracture Location

Hand Fractures by Locations in Adults Based on OTA Classification

Table 8.4 Fracture location distribution of 10009 hand fractures in adults

Hand Fractures by Locations in Children

Table 8.5 Fracture location distribution of 964 hand fractures in children

Carpal Fractures (Segments 71–76)

Anatomic Features

There are eight carpal bones, arranged in two rows. Those of the proximal row, from lateral to medial, are the scaphoid, lunate, triangular, and pisiform; those of the distal row, in the same order, are the trapezium, trapezoid, capitate, and hamate. From the proximal row, the superior articular surfaces of the scaphoid, lunate, and triangular bones are connected by ligaments, present a convex surface, and articulate with the inferior surface of the radius and articular disk, forming the radiocarpal joint; the distal row of carpal bones articulates with the proximal bases of the five metacarpal bones, forming the carpometacarpal joints.

Carpals are short bones; each bone (except the pisiform) has six surfaces. The anterior and posterior surfaces, which make ligamentous attachment, are rough. The surfaces where the carpal bones make contact with contiguous bones are all articular, thus covered with articular cartilage, and are involved in the formation of the joint. The construction of these short bones provides complex but limited movement.

OTA Classification of Carpal Fractures

Clinical Epidemiologic Features of Carpal Fractures (Segments 71–76)

A total of 450 carpal fractures in 442 adult patients were treated at our trauma center over a 5-year period from 2003 to 2007. All cases were reviewed and statistically studied; the fractures accounted for 4.50% of hand fractures in adults. Their epidemiologic features are as follows:

• more males than females

• the highest-risk age group is 21–30 years—the same age group for males, while there is no apparent high-risk age group for females

• scaphoid fractures (72) are the most common carpal bone fractures (71–76).

Carpal Fractures (Segments 71–76) by Sex

Table 8.6 Sex distribution of 442 patients with carpal fractures (segments 71–76)

Carpal Fractures (Segments 71–76) by Age Group

Carpal Fractures (Segments 71–76) by Fracture Type

Injury of Mechanism

Most carpal fractures are a result of axial loading on the outstretched palm and an extended wrist, for example from a fall on an outstretched hand or motor-vehicle collision. A direct blow to the dorsum of the hand, a crush injury, or cutting through the dorsum of the hand can also cause this type of injury.

Diagnosis

Most patients present with history of a fall on an outstretched hand, or a traumatic event like a motor-vehicle accident. If palpation of each carpal bone and the intercarpal ligaments elicits pain and apparent local tenderness, one should strongly suspect the presence of fractures. Where carpal fracture is suspected, X-rays of anteroposterior (AP), lateral, and oblique views are needed. Bone scans and computed tomography (CT) scans are sometimes helpful if the plain X-ray is inconclusive for fracture.

Treatment

Most carpal fractures can be treated with nonsurgical intervention, except scaphoid fractures. The indications for nonsurgical treatment are as follows:

• nondisplaced carpal fracture

• stable wrist joint injury, with less than 2 mm fracture displacement

• stable wrist joint injury, with less than 1 mm intra-articular fracture step-off

• isolated ligamentous rupture, in elderly low-demand patients

• hamate fracture with the hook intact

• pisiform fracture.