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Carpal Fractures, Emergency Medicine

Mary R. Mulcare and Wallace A. Carter Reviewed 06/2017
 


Basics

Description

  • Most commonly injured region of upper extremity

    • Most commonly fractured carpals are the scaphoid (68%) and triquetrum (18%)

  • Carpal bone fractures commonly occur with other wrist injuri...

Diagnosis

Signs and Symptoms

History

  • FOOSH or direct blow

    • Hyperflexion → dorsal avulsion fracture

    • Hyperextension → volar avulsion fracture

  • Hook of hamate fractures:

    • Associated with a forceful swing of a rac...

Treatment

Pre-Hospital

  • Prevent contamination of any lacerations overlying the area

  • Patients with swelling or significant pain at the wrist or hand:

    • Elevate extremity and apply ice

    • Remove jewelry, watches

    • I...

Follow-Up

Disposition

Admission Criteria

  • Open fractures are admitted for early operative irrigation and débridement

  • Patients with injuries requiring surgical management (open reduction, unstable displace...

Pearls and Pitfalls

  • Carpal fractures may not be apparent on initial radiographs and may lead to long-term disability if not treated appropriately

  • Splint all suspected fractures and refer for repeat rad...

Additional Reading

  • Goddard  N. Carpal fractures in children. Clin Orthop Relat Res.  2005;432:73–76.

  • Kouris  GJ, Schenck  RR. (2011, Feb 3). Carpal fractures. eMedicine. Retrieved 5/13/2013 from h...

Codes

ICD9

  • 814.00 Closed fracture of carpal bone, unspecified

  • 814.01 Closed fracture of navicular [scaphoid] bone of wrist

  • 814.03 Closed fracture of triquetral [cuneiform] bone of wrist

  • 814.07 Closed frac...

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