Crush injury of the carpus

Abstract

Severe crush injuries affecting the bones of the carpus are rare. We review the nine cases that have previously been described and report four additional cases which we have treated and followed up. All 13 present remarkable similarities, with disruption of the carpal arch through the capitate-hamate articulation distally and the piso-triquetral joint proximally. Three slightly different variations of this pattern of fracture-dislocation are identified. The flexor retinaculum must be involved to allow the displacement which is seen, and there is usually an extensive laceration of the thenar eminence. Treatment by closed reduction is usually successful. Long-term follow-up shows that, in the absence of nerve or vascular damage, the results are surprisingly good.

Paediatric multiple carpal fractures: A case report

“…The combination of a difficult to examine patient and the limited ability of X-rays to detail the immature skeleton are all contributing factors. [2][3][4][5][6][7] Our patient was almost skeletally mature and the fractures were clearly evident on X-ray.…”

“…[1][2][3][4][5][6][7][8] Single carpal bone fractures in children are uncommon. However multiple carpal fractures in this age group are very rare indeed.…”

“…All described cases displayed medial dislocation of the ulnar structures as one unit, whilst the radial carpal bones Injury Extra (2008) 39, 247-249 remained protected perhaps by the padding afforded by the thenar muscles. 3 The case may be different in children. Our patient sustained fractures of the capitate, hamate, triquetrum and pisiform (the ulnar-sided carpal bones) but with no medial dislocation.…”

“…Pin fixation provides temporary stabilisation without permanently compromising joint motion. [2][3][4][5][6] Little is documented on these combination injuries of the carpus in the English literature. Kamano et al reported a good clinical result in an 11-year-old in which displaced fractures of the scaphoid, capitate and hamate were treated with wire fixation.…”

“…Computerised tomograms confirmed the presence of fractures involving the capitate, hamate, triquetrum and pisiform (Figs. [3][4][5]. He was managed conservatively in a below elbow cast for 5 weeks.…”