Carpal Bone Fractures: Symptoms, Diagnosis & Treatment

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The wrist is a complex joint that provides flexibility, strength, motion, and stability to support innumerable actions every single day. It’s also one of the most commonly injured joints in the body and is involved in approximately 25% of all athletic injuries. Wrist injuries can have a significant impact on day-to-day life and must be treated proactively to ensure optimal healing and function moving forward.

If you have sustained a fall or other traumatic event and are experiencing acute or ongoing wrist pain, a carpal bone fracture (broken wrist) may be suspected. Eight carpal bones and their numerous articulations comprise the wrist joint, making the exact diagnosis of carpal bone injuries a sometimes intricate process that should be formally made by a wrist expert through clinical history, exam, x-rays, and at times advanced imaging. Below, we’ve provided an overview of carpal bone fractures, including their symptoms, diagnosis, and treatment:

Understanding Carpal Bone Fractures

Situated between the two bones of the forearm (the radius and ulna) and the long hand bones known as metacarpals, lie two rows of small bones tightly interwoven by numerous ligaments. These are the carpal bones that make up the human wrist joint.

The proximal carpal row (closer to the forearm) consists of the scaphoid, lunate, triquetrum, and pisiform bones, while the distal carpal row (closer to the hand) consists of the hamate, capitate, trapezoid, and trapezium bones.

Because of the complexity of the carpal bones’ shapes and articulations, injuries are sometimes misdiagnosed or missed altogether. Unfortunately, this can lead to chronic pain and complications later on, which is why the accurate and timely diagnosis and treatment of carpal bone injuries is crucial.

What Are Carpal Bone Fractures?

A carpal bone fracture refers to a fracture of any one of the eight carpal bones. While approximately 60-70% of all wrist fractures involve the scaphoid bone, injuries to the seven other bones can also occur under a variety of different circumstances. The second most commonly injured carpal bone is the triquetrum, while fractures of the remaining carpal bones represent rare carpal fractures.

Types of Carpal Bone Fractures

Because scaphoid fractures are so common, we have created a dedicated information page for scaphoid fractures here (**link once Scaphoid Fracture page is published)

The information below focuses on all other carpal bone fractures, including fractures of the lunate, hamate, trapezium, trapezoid, triquetrum, pisiform, and capitate.

Causes and Symptoms of Carpal Bone Fractures

Carpal fractures can occur under a variety of circumstances and can present in a number of different ways. In this section, we further discuss their causes and symptoms:

What Causes Carpal Bone Fractures?

Carpal bone fractures are most commonly caused by a fall onto an outstretched hand but can also be caused by a direct, traumatic blow or a high-impact event such as a car accident.

Certain mechanisms of injury are more likely to affect specific carpal bones than others. For instance, the hamate bone is typically fractured as a result of hitting a stationary object with a golf club or baseball bat, while the lunate bone is often fractured as a result of the heel of the hand hitting a hard surface. Triquetrum fractures, which are caused by wrist hyperextension, are often the result of participation in contact sports.

Common Symptoms of Carpal Bone Fractures

Not all carpal fractures present with the same symptoms. If you’re experiencing one or more of the following, seek medical advice immediately:

  • Swelling in or near the wrist
  • Bruising
  • Tenderness (may only be noticeable when palpated)
  • Decreased range of motion
  • Weakness or difficulty gripping
  • New onset numbness or tingling
  • Deformity or color change (generally only in severe cases where vascular damage has occurred)

Diagnosis of Carpal Bone Fractures

In order to properly diagnose a carpal bone fracture, your doctor will need to begin by gaining a thorough understanding of the mechanism of injury.  Specific carpal bones are more likely to be impacted by certain types of scenarios, so be sure to provide clear details about exactly how your injury occurred.

How Are Carpal Bone Fractures Diagnosed?

Once your doctor understands the circumstances surrounding your injury, they will perform a physical examination of your wrist, and typically a full series of X-rays. 

Further advanced imaging (CT or MRI scans) may be necessary if the fracture is complex or can’t be properly visualized on the X-rays. Advanced imaging may also be indicated if a carpal fracture is suspected despite negative X-rays.

Treatment Options for Carpal Bone Fractures

The primary goal of carpal bone fracture treatment is to restore full and pain-free wrist motion. In addition, treatment options should aim to reduce the risk of future arthritis in the carpal bones.

Non-Surgical Treatments

If a carpal bone fracture is nondisplaced (the bone retains its proper alignment) and non-dislocated (no dislocation has taken place), non-surgical treatment will likely be the preferred treatment option. Depending on the carpal bone that has been fractured and the severity of the injury, the wrist will be immobilized (splinted or put in a cast) for a number of weeks.

Surgical Treatments

If a carpal bone fracture is displaced (the bone has become misaligned) or a dislocation has also occurred, surgical treatment may be indicated. Open reduction and internal fixation (ORIF) is the most common surgery performed to repair carpal bone fractures. In more severe cases, screws or wires may be required to permanently stabilize carpal bones and hold them in place.

World-Class Treatment Options at Modern Orthopaedics of New Jersey

The award-winning team of orthopedic surgeons at Modern Orthopaedics of New Jersey has successfully treated carpal bone fractures for countless patients. Call our office today to book your appointment!

Recovery and Rehabilitation From Carpal Bone Fractures

In general, carpal fractures heal effectively, and the vast majority of patients are able to return to all activities with no restrictions. Because the scaphoid bone receives less blood supply than other carpal bones, it’s one of the slowest carpal injuries to heal. Your doctor or surgeon will be able to give you an accurate recovery time estimate based on the severity and nature of your particular injury.

Preventing Carpal Bone Fractures: Tips and Strategies

Carpal bone fractures happen, but there are many ways to lower the risk of this injury happening to you. If you’re concerned about wrist injuries, adhere to the following recommendations:

  • Maintain a healthy diet that strengthens your bones.
  • Stay fit and physically active (cultivate balance, strength, and flexibility).
  • Wear proper shoes when engaging in physical activity.
  • Wear protective equipment, such as wrist guards, when engaging in activities where there is the possibility of wrist injury.
  • Take precautions when climbing on a stepstool, chair, or ladder.

Ready to have your wrist pain properly diagnosed and treated? The exceptional team of surgeons at Modern Orthopaedics of New Jersey is always prepared to help. Contact us today to book an appointment!

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Peter DeNoble, MD

Peter DeNoble, MD, FAAOS

Hand, Wrist, Shoulder & Elbow Surgeon

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David Ratliff, MD, FAAOS

Hand, Wrist, Shoulder & Elbow Surgeon

David Ratliff, MD, FAAOS

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Hand, Wrist, Shoulder & Elbow Surgeon

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