What Are the Different Types of Carpal Bone Fractures?

Carpal bone fractures are common injuries that affect the wrist and can significantly impact hand function. The carpal bones are a group of eight small bones in the wrist that connect the forearm to the hand. Due to their intricate structure and role in movement, fractures in these bones require careful diagnosis and treatment.

This article explores the different types of carpal bone fractures, how they occur, and available treatment options, including Dupuytren's contracture surgery if needed.

Understanding Carpal Bone Anatomy

The eight carpal bones are arranged in two rows:

• Proximal row (closer to the forearm): Scaphoid, Lunate, Triquetrum, Pisiform
• Distal row (closer to the hand): Trapezium, Trapezoid, Capitate, Hamate

Each bone plays a vital role in wrist movement and stability. A fracture in any of these bones can cause pain, swelling, and limited range of motion.

Types of Carpal Bone Fractures

Scaphoid Fracture

A scaphoid fracture is the most common carpal bone fracture in Hatfield, often caused by falling on an outstretched hand (FOOSH injury).

• Symptoms: Pain and tenderness in the wrist, especially on the thumb side.
• Risk Factors: Common in young adults and athletes.
• Treatment: May require a cast for mild fractures, but severe cases may need surgery with screws or pins to promote healing.

Scaphoid fractures are known for slow healing due to limited blood supply, and untreated fractures can lead to arthritis or nonunion (failure to heal).

Lunate Fracture

A lunate fracture is rare but serious because this bone is central to wrist movement. It can result from high-impact trauma like car accidents or sports injuries.

• Symptoms: Wrist pain, swelling, difficulty gripping objects.
• Complications: Can lead to Kienböck's disease, a condition where the bone dies due to lack of blood supply.
• Treatment: Often requires casting, but advanced cases may need bone grafting or surgery.

Triquetrum Fracture

The triquetrum is the second most commonly fractured carpal bone, usually caused by falling on an outstretched hand or direct trauma to the wrist.

• Symptoms: Pain on the pinky side of the wrist, swelling, and tenderness.
• Diagnosis: Confirmed through X-rays or CT scans.
• Treatment: Most cases heal with a splint or cast, but displaced fractures may need surgical fixation.

Pisiform Fracture

The pisiform is a small pea-shaped bone on the pinky side of the wrist. Fractures are rare and usually occur from direct trauma, such as hitting a hard surface.

• Symptoms: Pain when pressing on the wrist, difficulty in wrist movement.
• Treatment: Immobilisation with a splint or cast; surgery is rarely needed.

Trapezium Fracture

A trapezium fracture can occur with thumb injuries or high-impact falls. This bone plays a key role in thumb mobility, making its fracture particularly limiting.

• Symptoms: Swelling, pain at the base of the thumb, difficulty gripping.
• Treatment: Minor fractures may heal with a splint, while severe cases need surgical repair.

Trapezoid Fracture

The trapezoid is the least commonly fractured carpal bone due to its protected position in the wrist. When fractured, it is usually part of a complex injury.

• Symptoms: Localised pain, swelling, and difficulty moving fingers.
• Treatment: Immobilisation in a cast or splint; surgery is rare.

Capitate Fracture

The capitate is the largest carpal bone and plays a crucial role in wrist stability. Fractures often result from severe trauma.

• Symptoms: Deep wrist pain, reduced range of motion.
• Treatment: A cast for minor fractures; surgical fixation for more severe cases.

Hamate Fracture

A hamate fracture is common in golfers, baseball players, and racquet sports athletes, as the hamate has a hook-like extension that is vulnerable to impact.

• Symptoms: Pain on the pinky side of the wrist, weakness when gripping objects.
• Treatment: May require surgery to remove the fractured bone fragment if healing is slow.

Diagnosis and Treatment Options

How Carpal Bone Fractures Are Diagnosed

Doctors use a combination of:

• Physical examination (checking for pain, swelling, and wrist movement limitations).
• X-rays (to identify fractures).
• CT or MRI scans (for complex fractures or suspected ligament damage).

Non-Surgical Treatments

• Immobilisation: Most minor fractures heal with a cast or splint worn for 4-8 weeks.
• Pain Management: Over-the-counter medications like ibuprofen can reduce pain and swelling.
• Physical Therapy: After healing, wrist exercises help restore strength and flexibility.

Surgical Treatments

• Internal Fixation: Screws or pins are used to stabilise the bone.
• Bone Grafts: Used for non-healing fractures.
• Fragment Removal: In cases like hamate fractures, removing part of the bone may relieve symptoms.

When Dupuytren's Contracture Surgery Is Needed

While Dupuytren's contracture surgery is not directly related to carpal fractures, some wrist injuries can contribute to scar tissue formation, leading to hand stiffness. Dupuytren's contracture is a condition where thickened tissue pulls fingers into a bent position, requiring surgical intervention to restore hand function.

Conclusion

Carpal bone fractures can range from minor hairline cracks to complex breaks requiring surgery. Early diagnosis and proper treatment are essential for recovery and preventing long-term complications.

If you experience wrist pain after an injury, seek medical attention to determine if a carpal bone fracture is the cause. For persistent stiffness or complications, treatments like Dupuytren's contracture surgery may also be necessary.