UNASSIGNED: Lunate fractures without associated dislocations are rare injuries, combination scaphoid-lunate fractures without an associated dislocation are even more rare of which few are reported in the literature.
METHODS: This case report describes a 16-year-old otherwise healthy male with ipsilateral scaphoid and lunate fractures after punching a goalpost with his left hand, for which he had surgical management. This patient had a successful treatment with two headless compression screws through a single extended carpal tunnel approach. Surgery was performed within two weeks of injury after initially immobilized with a thumb spica splint. The postoperative period was complicated by noncompliance with weight-bearing status and missed three-month followup. However, by six months, subsequent visits demonstrated radiographic and clinical healing as well as full wrist range of motion without any other sequelae.
UNASSIGNED: This case offers more evidence regarding this rare injury. Lunate fractures and scaphoid fractures can both be treated with open reduction and internal fixation using headless compression screws, however little evidence exists when it comes to treating them in combination.
CONCLUSIONS: The use of headless compression screws through a single extended carpal tunnel approach led to clinical and radiographic healing in a 16 year-old-male with combined scaphoid and lunate fractures at 6 month follow up.

Background: Lunate pseudarthrosis is a complication of lunate fractures and few cases are described in the literature. We designed a case series of lunate pseudarthrosis, to acknowledge this topic and to show our clinical experience. Methods: Four patients were included in this study. Three went through surgical treatment of lunate nonunion. Results: At 2 years\' follow-up, patients had slight improvement of range of motion (ROM) and Quick-DASH score compared to preoperative measures, though two patients developed scaphocapitate, radiolunate or midcarpal osteoarthritis. The fourth patient is asymptomatic and is being followed up. Conclusions: Surgical options depend on the localization of the pseudarthrosis in the lunate. Fragment excision can be a good option when the fragment is small, preserving scapholunate (SL) stability. Caution must be taken with dorsal pole pseudarthrosis, regarding midcarpal osteoarthritis. Level of Evidence: Level IV (Therapeutic).

Volar dislocation of the trapezoid is a rare injury and is easily missed. It is more common to have a dorsal dislocation of trapezoid or multiple carpometacarpal joint dislocations. The rare nature of the injury also means that there is little guidance in literature regarding optimal treatment. We are reporting the presentation, management and a 3-year follow-up of this rare injury in a 19-year-old male. Level of Evidence: Level V (Therapeutic).

UNASSIGNED: Carpal bone lesions are common, even in acute injuries or as sequalae of missed fractures. If not correctly diagnosed and treated, can lead to loss of function, especially in active patients. The surgical management remain difficult particularly in case of small, atypical or non-unions fragments. The treatment of heterogenic shape fractures should require a fragment specific fixation using, traditionally, Kirschner-wire (K-wire). This method of treatment remains the most popular but could be prone to some complication as: not stable fixation, need to long time immobilization and wire mobilization. Methods Nineteen patients presented with carpal bone lesions were treated by the use of HCS 1,5 mm headless compression screws. Patients were evaluated post-operative by Patient-Rated Wrist Evaluation (PRWE), the Visual Analogic Scale (VAS), Quick-DASH Score and the grip strength was measured by Jamar dynamometer.
UNASSIGNED: Authors observed improvement of pain control and common activity; fine movements were restored; we observed no post-operative functional instability.
UNASSIGNED: HCS 1,5 mm headless compression screws are suitable and smart technique to treat these uncommon fractures to achieve a stable primary fixation and allow an early mobilization and conciliate the versatility of K-wire and the compression action due to screws also in small bone fragment.

OBJECTIVE: The triquetrum is the second most commonly fractured carpal bone, comprising 15-18% of all carpal bone fractures. This review summarizes the current knowledge of triquetral fractures, including the anatomy and pathophysiology, evaluation and diagnosis, treatment and management, post-treatment outcomes, and complications.
RESULTS: Triquetral fractures are frequently caused by impaction of the ulnar wrist after a fall on an outstretched hand or by avulsion of attached ligaments. There are three main types of triquetral fractures: dorsal cortical fractures, triquetral body fractures, and volar cortical fractures. Dorsal cortical fractures are the most common and are usually benign, while volar cortical fractures are the least common and can be problematic. Nonsurgical management is indicated for most triquetral fractures, which usually results in good outcomes. Surgical treatment is indicated for fractures with significant displacement or evidence of instability. Complications of triquetral fractures include non-union, triangular fibrocartilage complex injury, and pisotriquetral arthritis. While less common than scaphoid fractures, triquetral fractures should remain in the differential diagnosis for patients with ulnar-sided wrist pain after falling on an outstretched hand. Most triquetral fractures can be treated with immobilization, though they should be thoroughly evaluated due to their potential to result in instability, loss of motion, and arthrosis. Further research is needed to determine the best method of surgical treatment.

Carpal fractures of bones other than the scaphoid occur at a much lower rate than scaphoid fractures. The close relationship between the carpus, intrinsic and extrinsic wrist ligaments, and wrist kinematics makes a thorough history, clinical examination, and interpretation of imaging for carpal malalignment essential. Carpal malalignment should be addressed with reduction and fixation. Nondisplaced fractures are often treated nonoperatively and displaced intraarticular fractures are almost always treatment operatively. The physician should keep in mind the athlete\'s specific goals and needs. Treatment must be individualized. Options for early return to play should be discussed when possible.

Hamate fractures are commonly divided into hook fractures and body fractures. The coronal fractures as a special form of hamate\'s body fracture are very rare injuries. Because of unspecific clinical findings and the mostly inconclusive x-ray imaging, these fractures are frequently overseen or misdiagnosed. This leads to further complications like secondary arthritis, persisting pain, and functional deficits in patient\'s wrist mobility. In our study, a collocation of coronal hamate fractures is analyzed and evaluated with respect to functional outcome after operative treatment and compared to the literature. Furthermore, we compare the strategies for diagnosis and treatment in our clinical center with those presented in the literature. Our standard in the initial diagnostic process is to obtain radiographs in an anterior-posterior, lateral, and 30° oblique view of the wrist. For further diagnosis and preoperative planning, a CT scan of the wrist is obligatory. Due to the high occurrence of comorbidities (especially CMC dislocations) all patients in our cohort obtained operative treatment. In long-term post-operative evaluation, we present the following results: The Manchester-Modified Disability of the Shoulder, Arm and Hand Score (M2 DASH) imposed with an average of 26.22 points (MD=22/ SD=11.31/MIN=18/MAX=52). None of the re-evaluated patients sorrowed for severe pain in rest. Four patients stated pain (ranging from 3 to 5 on numeric analogue scale) after heavy burden (e.g. boxing, weight lifting). In exploring the range of motion of the operated hand the following results are obtained: dorsal extension: average 83.33° (MD=85°/SD=3.54°/MIN=75°/MAX=85°), flexion: average 77.78° (MD=80°/SD=4.41°/MIN=70°/MAX=80°). Additionally, a performance testing was conducted: fist clenching sign: complete without pain in 100%, pinch grip: complete in 77.78%, opposition digitus manus I-V complete in 66.67%. The conservative treatment is not recommended (especially shown in the here presented \"add\" case with a misdiagnosed fracture). The open approach has its advantages compared to a closed operative procedure and should always be intraoperatively considered as an operative expansion.
Hamatumfrakturen werden in Hamulus-ossis-hamati- und Corpusfrakturen unterteilt. Die coronare Os hamatum Fraktur ist, als Sonderform der Corpusfraktur, eine sehr seltene Verletzung. Aufgrund der unspezifischen klinischen Symptomatik und unsicheren projektionsradiografischen Diagnostik wird dieser Frakturtyp in der Primärdiagnostik häufig übersehen oder fehldiagnostiziert. Dies führt zu möglichen Folgekomplikationen, wie posttraumatischer Arthrose, persistierender Schmerzzustände und funktioneller Defizite.In der vorliegenden Studie werden die an unserem Zentrum behandelten coronaren Hamatumfrakturen zusammengestellt, anhand des funktionellen Ergebnisses nach operativer Versorgung ausgewertet und mit der aktuellen Literatur verglichen. Weiterhin wird der diagnostische und therapeutische Algorithmus unseres Zentrums dem publizierten Standard gegenübergestellt.Standdarddiagnostikum sind Röntgenbilder des Handgelenks in drei Ebenen (anterior-posterior, streng seitlich, 30° schräg – Aufnahme). Zur weiteren Diagnostik und insbesondere präoperativen Planung ist die Computertomografie des Handgelenks obligat. Aufgrund des häufigen Vorhandenseins von Begleitverletzungen (insbesondere carpometacapale Dislokationen) wurden alle Patienten operativ therapiert. Im Rahmen der klinischen Langzeitevaluation zeigten sich folgende Resultate: Der Manchester-Modified Disability of the Shoulder, Arm and Hand Score (M2 Dash) lag im Durschnitt bei 26,22 Punkten (MD=22 / SD=11,31 / MIN=18 / MAX=52). Keiner der nachuntersuchten Patienten klagte über starke Ruheschmerzen. Vier Patienten gaben Schmerzen von 3–5 auf der numerischen Analogskala nach stärkerer Belastung (beispielsweise Boxen, Anheben von Lasten) an. Bezüglich des Range of Motion zeigten sich folgende Ergebnisse: Dosalextension: Durchschnitt 83,33° (MD=85° / SD=3,54° / MIN=75° / MAX=85°), Flexion: Durchschnitt 77,78° (MD=80° / SD=4,41° / MIN=70° / MAX=80°). In der Funktionsprüfung zeigten sich: Faustschluss vollständig und schmerzfrei in 100%, Pinzettengriff vollständig in 77,78% und Opposition Daumen–Kleinfinger vollständig in 66,67%.Insbesondere aufgrund des hier gezeigten fehldiagnostizierten Falles („add“ case) kann das konservative Vorgehen nicht empfohlen werden. Im Vergleich mit einem geschlossenen operativen Verfahren zeigt das offene Vorgehen seine Vorteile und sollte intraoperativ als mögliche Erweiterung in Erwägung gezogen werden.

Wrist and hand injuries are common among athletes, and can lead to considerable disability. Dislocations and soft tissue injuries are common and require prompt recognition and treatment. Accurate diagnosis and early immobilization are often key to getting players back to their sport early. Some injuries require surgery; operative intervention allows the player to return to their sport more quickly or with less long-term disability. This article discusses the spectrum of injury from distal radius fractures to mallet fingers, and offers some general guidelines for the surgeon in how to counsel and treat athletes with these problems.

Background Scaphoid fractures are common carpal fractures that are often misdiagnosed as wrist sprains and may go on to nonunion. The location of the fracture site may influence the stability of scaphoid nonunions. Purpose To determine whether the stability of a scaphoid nonunion depends upon the fracture\'s location, we tested the hypothesis that a simulated fracture distal to the apex of the scaphoid dorsal ridge will have greater interfragmentary motion than proximal. Methods Eleven cadaver wrists were moved through three wrist motions using a wrist simulator. In six wrists, a fracture was created distal to the scaphoid apex, and in five a fracture was created proximal to the apex. Sensors attached to the distal and proximal parts of each scaphoid measured the interfragmentary motion during wrist motion. Results In those wrists in which the scaphoid was sectioned distal to the apex, the distal fragment became significantly more unstable relative to the proximal fragment. It flexed, ulnarly deviated, and pronated. These motion changes were less when the scaphoid was sectioned proximally. Discussion Scaphoid fractures distal to the scaphoid apex will have greater interfragmentary motion. The mobility of the fragments at the fracture site is possibly a more important contributory factor of nonunion in scaphoid waist fractures than for proximal scaphoid fractures. Clinical Relevance Understanding the effect that the location of a scaphoid fracture has on the potential for nonunion may influence the modalities of treatment and follow-up.

Carpal fractures are uncommon, but if missed, can lead to morbidity and loss of function, especially in an athlete. Early diagnosis through physical examination, plain radiographs, and possibly advanced imaging is paramount. Treatment is specific to each fracture type, and return to play varies with each clinical scenario. This article organizes current knowledge of these potentially difficult fractures with a table of diagnoses and treatment guidelines.