Release notes of Carpal bones

The content has been revised by Pavel Dráč (CZ) and Matej Kastelec (SI) with Simon Lambert (UK) as executive editor.

Fabio Suarez authored the section on dislocation and fracture-dislocation of the carpometacarpal joints.

The main differences to the first edition are:

• Hamate hook fracture management
• Tubercle avulsion fractures
• Differentiation of lesser arc and greater arc injuries
• Description and indications for scaphoid dissociation, lunocapitate and midcarpal dislocation, and lunate dislocation

Pages on the following topics have been added:

• Classifications
• Dislocation and fracture-dislocation of the carpometacarpal joints
• Patient assessment and preparation
• Complications and technical failures
• Basic technique on headless compression screw fixation

The following videos have been added:

• Scaphoid-Fracture – Percutaneous Fixation with the 3.0 mm Headless Compression Screw (HCS)
• Wrist joint – Dorsal approach
• Wrist joint–Scaphoid bone – Palmar approach

The material of the carpal bones, second edition, includes a detailed description of the following injury types and their management.

Isolated fractures

Scaphoid waist fracture:

• Nonoperative treatment
• Percutaneous screw fixation through a palmar approach
• Percutaneous screw fixation with combined approaches
• ORIF through a palmar approach - Retrograde screw fixation
• ORIF through a dorsal approach - Antegrade screw fixation
• ORIF - Palmar plating

Proximal pole fracture of the scaphoid:

• ORIF through a dorsal approach - Antegrade screw fixation

Scaphoid tubercle fracture:

• Nonoperative treatment

Hamate hook fracture:

• Nonoperative treatment
• Hook excision
• ORIF - Screw fixation

Lesser arc injuries

Scapholunate dissociation:

• Arthroscopically assisted ligament repair
• ORIF - Scapholunate reduction and ligament repair

Lunocapitate and midcarpal dislocation:

• Closed reduction - Splinting (preliminary treatment)
• ORIF - Scapholunate reduction and ligament repair
• ORIF - Scapholunate and lunotriquetral ligament repair

Lunate dislocation:

• Closed reduction - Splinting (preliminary treatment)
• Open reduction - Ligament repair

Greater arc injuries

Perilunate fracture-dislocation:

• Closed reduction - Splinting (preliminary treatment)
• ORIF

Carpometacarpal injuries

Dislocation and fracture-dislocation of the carpometacarpal joint:

• Reduction - Immobilization
• ORIF

Approaches:

• Palmar approach to the scaphoid
• Dorsal approach to the scaphoid
• Minimally invasive palmar approach to the scaphoid
• Combined approach to perilunate fractures and dislocations
• Ulnar approach to the hamate hook
• Dorsal approach to the carpometacarpal joints

Patient positioning:

• Supine patient position

Further reading:

• Patient assessment
• Classifications for fractures of carpal bones
• Perilunate injury classification
• Complications and technical failures
• References

Basic techniques:

• Bone graft addition
• Headless compression screw
• Splinting
• Immobilization with a cast

The content has been created by Renato Fricker (CH), Matej Kastelec (SI), Fiesky Nuñez (VE), and Terry Axelrod (CA) with Chris Colton (UK) as executive editor.

The material of the carpal bones, first edition, included a detailed description of the following injury types and their management.

Scaphoid waist:

• Nonoperative treatment
• Percutaneous screw fixation
• Screw and K-wire fixation

Scaphoid, proximal pole:

• Prograde screw fixation

Perilunate dissociation:

• ORIF of lunotriquetral dissociation
• Ligament repair of scapholunate dissociation

Perilunate dislocation:

• Open reduction, internal fixation (ORIF)

Perilunate fracture-dislocation:

• Open reduction, internal fixation (ORIF)

Approaches:

• Palmar approach to the scaphoid
• Dorsal approach to the scaphoid
• Minimally invasive access to the scaphoid
• Combined approach to perilunate fractures and dislocations

Further reading:

• Common mistakes in hand surgery
• Fractures with a defect: Add bone graft
• References