Paediatric multiple carpal fractures: A case report

Abstract

An 11-year-old boy presented after sustaining an injury to his dominant right wrist after a brick wall had collapsed onto it. Standard radiographs of the hand were obtained displaying multiple carpal bone fractures (Figs. 1 and 2). Computerised tomograms confirmed the presence of fractures involving the capitate, hamate, triquetrum and pisiform . He was managed conservatively in a below elbow cast for 5 weeks.At 2-month follow-up he was completely pain free and the right wrist was minimally more swollen then the left. The patient was able to palmar/dorsi-flex to 50% on the right in comparison to the left. However a full range of pronation/ supination was present. At this stage radiographs revealed the capitate and hamate had yet to unite.At 4-month follow-up he remained asymptomatic; he recovered his full range of movement. Radiographs showed a healing capitate fracture. At 6-month follow-up he had a fully functioning non-painful wrist and was discharged from clinic.The patient was recalled to clinic at 3 years. He was asymptomatic, using his wrist fully and was participating in all sports including goalkeeping in football. On examination the wrist was normal with no swelling and no deformity. There was no tenderness on palpation and no pain on stressing the wrist. Active range of motion was full and equal to the normal wrist. Radiographs revelaed that the capitate fracture had united but the hamate fracture remained ununited (Figs. 6-9). This was confirmed on CT scanning. DiscussionFractures and dislocations in the paediatric carpus are extremely rare. As an anatomical structure the immature carpus is a relatively cartilaginous and therefore fairly immune to injury.Carpal injuries are often a diagnostic and therapeutic conundrum. The combination of a difficult to examine patient and the limited ability of X-rays to detail the immature skeleton are all contributing factors. 2-7 Our patient was almost skeletally mature and the fractures were clearly evident on X-ray.The Scaphoid is the most frequently injured carpal bone in children, and in adults; one of the few similarities in skeletally mature and immature patients. 1-8 Single carpal bone fractures in children are uncommon. However multiple carpal fractures in this age group are very rare indeed. Goddard emphasises the importance of being aware of the possibility of combination injuries (particularly in association with distal radial fractures) and the value of MRI in excluding ligamentous damage. 2 Garcia-Elias et al. proposed that crush injuries of the adult carpus involved a disruption of the transverse carpal arch. There is involvement of the flexor retinaculum and the capito-hamate and piso-triquetral joints. It was postulated that these joints acted as a ''weak zone''. All described cases displayed medial dislocation of the ulnar structures as one unit, whilst the radial carpal bones Injury Extra (2008) 39, 247-249

Fractura aislada del hueso grande asociada a quiste traumático sinovial: presentación de un caso en un niño

“…Existe poca bibliografía relacionada con las fracturas aisladas del hueso grande en niños; encontramos un total de 38 casos descritos hasta la fecha, 3,7,8 los más frecuentes son los casos asociados a fracturas de escafoides 9 o a múltiples fracturas del carpo. 10 El mecanismo de lesión principal ocurre por traumatismo directo y, aunque la localización puede ser variable, en general, estas fracturas pueden clasificarse en tres grupos según describen, de forma gráfica, Kadar y cols. 3 Uno de los grupos es el de las fracturas del cuerpo, que incluye las fracturas conminutas, las oblicuas y las transversales; esta última localización es la más frecuente.…”

Fractures of the Scaphoid, Capitate and Triquetrum in a Child: A Case Report

“…Nonetheless, in a study, an 11-yearold with multiple undisplaced carpal fractures was treated conservatively and achieved adequate fracture healing. 9 Further magnetic resonance imaging may aid diagnosis and reveal displacement of carpal fractures in children, [9][10][11] as radiographs fail to reveal fractures in 37% of children with hand or wrist injuries. 12 A high level of suspicion is therefore important in children with hand or wrist injuries.…”

Fractures Of The Hamatum And Capitatum In A Child: A Case Report

“…Fractures of the carpal bones are rarely seen in children, particularly in the first decade of life. Scaphoid fractures are the most common carpal bone injuries reported during this period of life (1)(2)(3)(4), whereas fractures of the other carpal bones are rarely seen and have generally been described as case reports or small series of patients in the literature (1,2) (5,6).…”