Bilateral carpal pilon-type fractures due to clenched fist trauma: a case report

Abstract

Background 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. Case Description 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. Conclusions 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.

Bilateral Scaphoid Fractures: A Systematic Literature Review

“…However, in contrast to the findings for unilateral fractures, the most frequently associated injury, reported in 31.25% of patients (n = 5), is bilateral dislocation of the carpal bones, likely attributable to the increased intensity of trauma, often caused by falls from a height. In two cases described by Afshar A. et al [20] and Reigstad O. et al [24], accounting for 12.5% of cases, associated fractures of other carpal bones were identified: in the first case, a bilateral trans-capitate fracture was associated with perilunate dislocation while, in the second case, fractures of the capitate and hamate on the left and only the capitate on the right were observed. Kay R.M.…”

“…In one case (n = 1; 6.25%), a B2 fracture on the right and a B3 fracture on the left were reported [15]. In another case, an A2 fracture on the right and a B1 fracture on the left were observed [24]. Additionally, two cases presented a B2 fracture on the left and a D2 fracture on the right [1,18].…”

“…In 75% of the cases (n = 12), the injury mechanism involved high-energy trauma. Specifically, 37.5% of the cases (n = 6) resulted from falls from a height [11][12][13][14]20,23], 6.25% (n = 1) were related to a traffic accident [24], 18.75% (n = 3) were associated with falls onto both outstretched hands [15,16,19], and 12.5% (n = 2) were attributed to sports-related trauma (Table 2) [1,21]. Four patients (n = 4; 25%) did not disclose specific traumatic events; instead, they reported multiple minor traumas occurring repeatedly over time, categorizing these fractures as stress fractures [17,18,22,25].…”

“…In 68.75% of cases (n = 11), associated wrist injuries were identified; of these, 36.36% (n = 4) presented with bilateral distal radius fractures [11,14,21,23], 45.45% (n = 5) had bilateral dislocations of carpal bones [13,16,19,20,23], and 18.18% (n = 2) had bilateral non-scaphoid carpal bone fractures [20,24]. In 6.25% of cases (n = 1), a bilateral proximal radius fracture was described [12], while, in 12.5% of cases (n = 2), injuries to the vertebral column were reported [11,14].…”

“…The remaining 68.75% (n = 11) underwent surgery. Among these, 72.73% (n = 8) were treated with headless compression screws [13,14,16,[18][19][20]23,24], 9.09% (n = 1) were treated with headless compression screws and bone grafting [1], 9.09% (n = 1) were treated with percutaneous fixation with k-wires [21], and 9.09% (n = 1) underwent a two-stage procedure that included fracture curettage, bone graft from iliac crest, and fixation with headless compression screws, first the right side and then the left side after 6 months [25].…”