Diagnosis and Treatment of Special Types of Carpal Fractures

        The distinctive configuration and intricate architecture of the carpal bones often lead to fractures involving these bones being commonly overlooked or inaccurately diagnosed, which can result in significant functional disability. Consequently, the precise diagnosis and treatment of carpal bone fractures is of paramount importance.

        A retrospective analysis was conducted on the cases of carpal fractures in our hospital from June 2019 to June 2023, excluding common injury cases such as simple scaphoid fracture and lunate fracture and dislocation. A total of 86 cases of special types of carpal fractures were obtained, including 20 cases of hamate fracture, 7 cases of trapezium fracture, 5 cases of trapezoid fracture, 4 cases of pisiform bone fracture, 3 cases of triquetral bone fracture, 41 cases of multiple carpal fractures, and 6 cases of carpal fracture with nerve injury.Among them, 12 cases were treated conservatively, and 74 cases were treated surgically. The wrist function recovery was observed at 1, 3, 6, and 12 months after treatment to evaluate the therapeutic effect.

         All the patients included in the treatment were followed up for 6-28 months after surgery. Among the 12 cases treated conservatively, 9 cases healed within 1.5-3 months, and 3 cases were converted to surgically treatment. The 74 cases treated surgically achieved bone healing at an average of 3 months after surgery, among which 5 cases had residual joint pain symptoms, and 2 cases had residual nerve injury symptoms. The comprehensive evaluation of the cure rate after surgery was 89.1%.

        Carpal fractures are often hidden and easily missed. It is difficult to make a definitive diagnosis with only ordinary wrist X-ray films, and special position X-ray examinations are needed. When suspected of trapezium fracture, wrist pronation oblique examination should be added; when suspected of hamate or pisiform fractures, carpal tunnel incision imaging should be added. If necessary, wrist CT examination can be performed to clarify the location and displacement of the fracture. This can improve the early diagnosis rate. In treatment, the stability and flexibility of the wrist should be considered. For non-displaced fractures, plaster fixation should be taken for 4-6 weeks. In surgical treatment, Kirschner wire cross fixation should be used after direct vision reduction. When taking the palmar approach, attention should be paid to the protection of the ulnar nerve. When taking the dorsal approach, attention should be paid to reduction and repair of the intercarpal ligament. Functional exercise should be carried out as soon as possible to promote the recovery of wrist function.

Keywords: carpal fractures，hamate fracture，trapezium fracture, trapezoid fracture, pisiform bone fracture, triquetral bone fracture