UNASSIGNED: Multiple carpal fractures or fracture dislocations can be devastating to the wrist. Despite anatomical reduction and ligament reconstruction, reduced function and arthrosis is often observed. Simple fractures without ligament injuries often fare well if anatomy is restored and the fracture heals.
UNASSIGNED: A 17-year-old autistic man presented with pilon-type bilateral fractures of the carpals after crashing his bicycle in a car with clenched fists around his bicycle handlebars. He had a displaced scaphoid, minimal displaced capitate and an undisplaced hamate fracture on the left side and an undisplaced scaphoid and displaced two-part capitate fracture on the right side. The fractures were reduced and stable fixation with screws performed. He was immobilized for 2 weeks and allowed early active motion. At 8 weeks the fractures had healed, and he obtained good function. At final follow-up after 6 months his nearest of kin reported excellent function, he had returned to his preinjury activity level. Range of motion and grip-strength was excellent and symmetrical. Radiographs and CT scans revealed healed fractures in anatomical position, no sign of ligament injuries, carpal instability or arthrosis.
UNASSIGNED: Multiple carpal fractures are not necessarily prone to reduced wrist function, pain and arthrosis, even in bilateral cases. If the ligaments are intact, stable fixation obtained and early mobilization obtained the fractures reduced and stable fixation obtained excellent hand and wrist function can be obtained.

Scaphoid and carpal bone fractures are challenging injuries to manage and have significant functional implications. Prompt diagnosis is important and relies on systematic evaluation via history, examination, and imaging. Cross-sectional imaging is often helpful for diagnosis and treatment planning. Treatment for nondisplaced fractures is often closed but these injuries typically require prolonged immobilization and may still result in nonunion or avascular necrosis. Displaced carpal bone fractures, and those associated with carpal instability, typically require open reduction internal fixation.

UNASSIGNED: Scapho-capitate syndrome is a rare variety, usually occur during high-energy trauma leads to fracture of scaphoid and capitate with 180 rotation of proximal fragment of capitate.
UNASSIGNED: We present a unique case of chronic neglected scapho-capitate syndrome, in which the rotated proximal fragment of capitate along with the early degenerative changes in capitate and lunate.
UNASSIGNED: Exploration of the wrist by dorsal approach, fracture fragment was resorbed and non-amenable for fixation. The scaphoid and triquetrum were excised. The cartilage between the lunate and capitate was denuded and arthrodesis was performed by 2.5 mm headless compression screw. The articular branch of the posterior interosseous nerve (PIN) was excised for pain relief.
UNASSIGNED: Accurate diagnosis in acute injury is essential for functional outcome. In chronic cases, magnetic resonance imaging is necessary to know the status of cartilage for planning of surgery. Limited carpal fusion with neurectomy of articular branch of PIN can give adequate pain relief and improvement in wrist function.

Because of their low incidence, studies about carpal fractures are rare. The aim of the present study was to analyze epidemiology and treatment of fractured carpal bones. We retrospectively analyzed data of 178 patients admitted to our emergency room with carpal fractures over 6 years. More males than woman were injured. In 91%, a CT scan was performed. The most commonly affected bone was the triquetrum followed by the scaphoid. Almost all triquetral fractures were treated conservatively as opposed to perilunate dislocations that were all operated on. Half of all patients with scaphoid fractures were operated. Young men had the highest risk to sustain a carpal fracture. The triquetrum and the scaphoid are most frequently affected. Usually a CT scan is needed. Treatment of scaphoid and perilunate luxation fractures is rather operative whereas the other fractures mostly allow conservative casting. Nevertheless, correct indication for treatment is important to avoid sequelae.

A 35-year old healthy male trauma surgery chief resident, suffered a high-speed motor vehicle collision. The patient sustained the following injuries: a Gustilo-Anderson grade 2 open comminuted intra-articular fracture of the left distal femur (AO 33C3.3), a Hawkins 1A neck fracture of the right talus (AO 81.2A), an undisplaced Lisfranc injury of the right foot comprising avulsion fractures at the base of the 1st, 2nd and 5th metatarsal as well as the cuboid bone suggesting ligament injury and 2nd to 5th carpometacarpal dislocations of the right (non-dominant) hand with comminuted fractures of the capitate, hamate, trapezoid and the base of the fifth metacarpal bone. A staged-treatment approach ensued. An external fixator (ex-fix) was placed over the left knee, followed by definitive fixation of the distal femoral fracture using a Qwix screw, Non-Contact Bridging (NCB) plate and Locking Compression Plate (LCP). An ex-fix was placed over the right wrist, followed by open reduction and k-wire fixation. The talar fracture of the right foot was treated with a single lag screw and the Lisfranc injury was treated non-operatively with four weeks of non-weight bearing cast immobilization. An intensive clinical rehabilitation program was started, including early use of Continuous Passive Motion (CPM), daily non-weightbearing swimming pool exercises, hand, physical and recreational therapy. One year after the injury the patient was rehabilitated and resumed his surgical residency. Two years after the injury, limited flexion and pain in the left leg remains, possibly related to partial union of the femoral fracture. Range of motion (ROM) of the right ankle and wrist remains limited, not causing significant functional impairment. Lessons learned from a patient experience combined with detailed descriptions of injuries, rehabilitation and long term outcomes can be used as a reference for treating patients with comparable injuries.

In recent decades, there has been a trend toward increased use of operative treatment of hand fractures. However, internal stabilization with wires or open reduction and internal fixation of the phalanges and the metacarpals carries a risk of surgical complications that can be avoided by using appropriate conservative treatment. In this article, some hand fractures that can be managed safely without surgery are discussed. In conclusion, when facing a fracture in the hand, the first consideration is whether the fracture can be treated nonoperatively and not which operative treatment is most appropriate. This applies to both displaced and undisplaced fractures.

The optimal protocol for postoperative immobilization following operative treatment of scaphoid fractures remains controversial. Reports of successful management with brief postoperative immobilization suggest that earlier restoration of function may be achieved by limiting the duration of immobilization. However, the risk of nonunion and its associated complications suggest that a more conservative approach with extended immobilization could optimize fracture healing. This paper presents a thorough review of the relevant literature and summarizes the myriad postoperative immobilization protocols and their reported outcomes. Postoperative immobilization protocols and reported outcomes for displaced, comminuted, and proximal pole fractures are discussed separately. The literature is reviewed following different operative techniques, including open reduction internal fixation and percutaneous screw fixation. Vigilant postoperative care of scaphoid fractures managed surgically is warranted to monitor for signs of nonunion while attempting to regain motion and strength to the injured wrist.

Hook of hamate fractures are uncommon injuries with unclear prevalence. Classic presenting symptoms include volar-ulnar hand/wrist pain and weakness in grip, with possible ulnar nerve paresthesias. Patient factors, such as activity level and desired return to work/sport, shape the most appropriate treatment regimen although excision of the hook has been adopted by most surgeons. Overall, once patients receive the correct diagnosis and are treated, good outcomes with high satisfaction rates are expected.

OBJECTIVE: Occult radiocarpal fractures often present a diagnostic challenge to the emergency department. Accurate diagnosis of these injuries is crucial as a missed fracture can lead to significant morbidity. Cone-beam CT (CBCT) scan is a novel imaging modality, with minimal radiation exposure and comparatively fast acquisition time. Our aim was to evaluate its use in the diagnosis of cortical fractures in the upper limb extremity.
METHODS: We conducted a systematic review of literature and included all studies that evaluated the use of CBCT in the diagnosis of radiocarpal fractures. We used a mixed-effects logistic regression bivariate model to estimate the summary sensitivity and specificity and constructed hierarchical summary receiver operative characteristic curves (HSROC).
RESULTS: We identified 5 studies, with 439 patients, and observed CBCT to be 87.7% (95% CI 77.6-93.6) sensitive and 99.2% (95% CI 92.6-99.9) specific for scaphoid fractures. For carpal fractures, CBCT was observed to have a pooled sensitivity and specificity of 90.6% (95% CI 72.7-97.2) and 100% (95% CI 99-100) respectively. For distal radius fractures, CBCT sensitivity was 90% (95% CI 67-98) and specificity was 100% (95% CI 10-100). The overall inter-rater agreement effect was shown to be 0.89 (95% CI 0.82-0.96), which is deemed to be almost perfect.
CONCLUSIONS: CBCT is an accurate diagnostic tool for occult radiocarpal cortical fractures, which could replace or supplement radiographs. We believe CBCT has a promising role in the acute radiocarpal fracture diagnostic algorithm in both emergency and trauma departments.

BACKGROUND: The purpose of this study was to assess factors affecting fixator stiffness with a finite element model and an experimental validation with particular attention to a new fixator device named Mutifix Wrist® (NCS Lab srl, Carpi, MO, Italy).
METHODS: Mechanical tests were carried out to determine the stiffness of the construct with different configurations. The obtained results were compared to those obtained with the Hoffmann II Compact (Howmedica-Osteonics Inc. Rutherford, NJ, USA). Data were sampled at 20 Hz and test speed was 0.05 mm/s. For each loading condition, tests were performed four times. A FEM campaign was also conducted to analyze how geometrical variables (type of configuration and K-wire diameter) affect both stiffness and stress distribution of the fixator.
RESULTS: Stiffness, axial displacement, magnitude of the displacement, magnitude and localization of the peak stress of the construct were all analyzed. Axial compression tests showed that the axial displacement reached by the machine actuator when the measured force reached 45 N was 0.56 mm ± 0.13 on average. Magnitude of the displacement along with peak stress magnitude and localization varied through the several configuration tested, but it resulted that the distal pin near the fracture gap was the more stressed one in all cases except those in which the fracture line is crossed.
CONCLUSIONS: From the tests performed, it emerged that the addiction of a K-wire provides a construct stiffening and a consequent local stress reduction; while span increase reduces stiffness and increase the local stress. If a K-wire is implanted through the fracture site, the axial stiffness is significantly increased.