Classifications for fractures of carpal bones

The Herbert classification is often used to describe scaphoid fractures. It is helpful when selecting the appropriate treatment.

A – acute stable (may be treated conservatively)

• A1 – fracture of the scaphoid tubercle
• A2 – nondisplaced crack of the wrist (incomplete fracture)

B – acute unstable (indicated for surgery)

• B1 – distal oblique fracture
• B2 – complete waist fracture
• B3 – proximal pole fracture
• B4 – fracture dislocation
• B5 – comminuted fracture

C – delayed union

D – established nonunion

• D1 – fibrous nonunion
• D2 – sclerotic nonunion (pseudoarthrosis)

• Nick G, Lasanianos NG, Doudoulakis KJ. Scaphoid Fractures. In: Lasanianos NG, Kanakaris NK, Giannoudis PV. ed. Trauma and Orthopaedic Classifications. A Comprehensive Overview. London: Springer-Verlag; 2015:107–113.
• Herbert TJ. The fractured scaphoid. St Louis: Quality Medical Publishing; 1990:51–67.

Hamate fractures are commonly classified after Hirano:

• Type I: fractures of the hamate hook
• Type II: fractures of the hamate body, subdivided in coronal and transverse fractures, IIa and IIb, respectively

Type IIa fractures are part of CMC fracture-dislocations. Type IIb fractures are rarely isolated and usually part of a greater arc injury.

• Hirano K, Inoue G. Classification and treatment of hamate fractures. Hand Surg 2005, 10: 151-157.