Definition

A carpal fracture refers to a break in one or more of the small bones that make up the wrist. These wrist bones, known as the carpals, are located between the forearm bones, the radius (next to the thumb) and ulna (on the pinky side), and the hand bones called metacarpals. There are eight carpal bones: scaphoid, lunate, triquetrum, pisiform, trapezium, trapezoid, capitate, and hamate.

While fractures in other carpal bones often accompany other injuries in the upper limb, isolated fractures can happen from direct trauma to the hand. In general, carpal fractures may result from both direct impacts and indirect forces transmitted through the wrist.

Hand fractures, including those involving the carpal bones, are among the most frequently seen bone injuries—making up around 18% of all fractures. The scaphoid bone is the most commonly fractured carpal bone, accounting for 50% to 80% of all hand fractures.

Carpal fractures tend to occur more often in younger individuals or those who are physically active. A typical injury happens when someone falls and uses their hand to break the fall, putting full body weight on an outstretched arm. Scaphoid fractures occur at an estimated rate of 120 per 100,000 people annually.

These types of fractures, particularly in the scaphoid, can be hard to detect right away on physical or imaging tests and may initially be mistaken for a wrist sprain. If not diagnosed and treated early, the injury can progress to arthritis, wrist deformities, instability, and in the long term, serious functional impairment.

Causes

Carpal fractures are usually caused by sudden trauma, either directly to the wrist or indirectly through force transferred during a fall. Many patients develop wrist pain after landing on their palm with the hand fully extended, which can place a great deal of pressure on the carpal bones, especially the scaphoid.

Common causes include sports injuries (e.g., skiing), road traffic accidents, or a strong blow to the wrist. These injuries often go unnoticed because carpal bones are small and are overshadowed by injuries to larger surrounding bones. Less commonly, bone infections like osteomyelitis or conditions like bone tumors can lead to carpal fractures, though such causes are very rare.

Risk Factor

• Age: Carpal fractures are more likely in younger adults who engage in high-impact sports or physical activity, increasing their chances of falling with their hands outstretched.

• Trauma from vehicle collisions: These fractures may also occur alongside other bone injuries due to a significant force impacting the hand.

Symptoms

Signs of a carpal fracture often appear immediately after injury. Most patients report wrist pain, swelling, and tenderness over the injured area. Since wrist bones are closely connected to nerves, carpal fractures can also lead to nerve-related issues.

Scaphoid fractures commonly cause pain on the thumb side of the wrist and are aggravated by movement. Swelling and tenderness in this area often limit wrist motion.

Hamate fractures are frequently seen in individuals who play sports that involve swinging motions, such as tennis or golf. The pain is usually on the pinky side of the wrist and can reduce grip strength. These fractures may also affect the ulnar nerve, causing tingling in the ring and little fingers and possibly muscle weakness in areas controlled by that nerve.

Diagnosis

Carpal fractures are frequently overlooked in early stages, so an accurate and timely diagnosis is essential to avoid long-term complications or permanent disability. Diagnosis typically begins when a patient reports focused wrist pain, especially when aligned with known trauma, such as falling onto an outstretched hand or receiving a direct impact to the palm or wrist.

The doctor will evaluate for tenderness over the carpal bones, observe restricted hand movement due to swelling and discomfort, and check for signs of nerve involvement. A test of nerve and blood vessel function (neurovascular test) is also necessary to identify potential complications.

While a standard X-ray of the hand can reveal a fracture, some carpal bone injuries, especially scaphoid fractures, are easily missed in early imaging. For a clearer and more precise view, the doctor may order a CT scan or MRI to assess bone structure and surrounding tissues in greater detail.

Management

Initial care for bone and muscle injuries should begin with immobilizing the area, applying cold compresses, and taking non-prescription pain relievers. Immobilization is key to minimizing further damage, reducing inflammation, and relieving discomfort. For suspected carpal fractures, wrapping the wrist with an elastic bandage can help reduce movement and swelling.

After initial care, further treatment depends on the fracture’s severity and whether other structures (such as nerves or vessels) are involved. Management may be non-surgical or surgical. The best course of action is chosen by a healthcare professional based on the individual’s condition and type of fracture.

Complications

If a carpal fracture is not properly diagnosed or treated in time, several complications may develop:

• Non-union: One of the most common complications, this occurs when the broken bone pieces fail to fuse due to the presence of very small or shattered fragments.

• Avascular necrosis: A serious condition in which the blood supply to the bone is disrupted. This is seen in about 30–40% of cases, especially in fractures of the scaphoid bone.

• Delayed union: A condition where the bone takes longer than expected to heal.

• Paralysis: May result if the fracture involves nerve damage, leading to loss of movement or sensation in part of the hand.

Prevention

Preventing carpal fractures mainly involves reducing risk factors during high-impact activities. Here are a few helpful tips:

• Be cautious during sports or physical exercises where falls or hand impacts are likely. Try to avoid falling in a way that causes the body’s weight to land on the hands.

• Wear proper protective gear on the hands during high-risk activities.

• Keep your joints and muscles strong and flexible through regular exercise.

When to See a Doctor?

If you experience wrist pain after a blow or fall, especially if the pain is located deep in the wrist area, you should consult a doctor after administering basic first aid. Early medical intervention is crucial to ensure proper healing and prevent serious complications.

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