From the Guidelines
Surgical fixation is the usual treatment for carpal fractures, especially when fracture fragments are large, articular, or significantly displaced, as it helps to prevent complications like nonunion, malunion, or post-traumatic arthritis. When considering treatment options for carpal fractures, it's essential to prioritize morbidity, mortality, and quality of life as outcomes. According to the American College of Foot and Ankle Surgeons, the diagnosis of a carpal fracture is based on a history of trauma and focal pain on palpation, confirmed with radiographic studies 1. Simple immobilization may be appropriate when fracture fragments are small, nonarticular, or minimally displaced. However, unstable or displaced fractures often require surgical fixation with pins, screws, or plates to ensure proper healing and prevent long-term complications. Pain management and rehabilitation are also crucial components of treatment, including rest, ice, elevation, and physical therapy to restore strength and range of motion. In general, the treatment of carpal fractures should be guided by the principles of minimizing morbidity, reducing mortality, and improving quality of life, as outlined in recent studies on the treatment of distal radius fractures 1. Some key considerations in the treatment of carpal fractures include:
- The specific bone fractured and its location
- The severity of the fracture and the amount of displacement
- The patient's overall health and medical history
- The potential risks and benefits of different treatment options. By prioritizing these factors and using the most recent and highest-quality evidence, healthcare providers can make informed decisions about the best course of treatment for patients with carpal fractures.
From the Research
Definition and Incidence of Carpal Fractures
- Carpal fractures are one of the more commonly overlooked fracture types, with an incidence of 30-60 per 100 000 persons per year 2.
- They can have serious consequences, as the use of the hand is indispensable in everyday life.
Diagnosis of Carpal Fractures
- Diagnosis involves clinical history-taking, physical examination, and x-ray, followed by thin-slice computed tomography as part of the diagnostic evaluation 2.
- Early recognition and appropriate treatment of carpal fractures lead to healing in more than 90% of cases 2.
Treatment of Carpal Fractures
- Treatment recommendations are based on evidence of levels II to IV, with multiple RCTs carried out on the treatment of scaphoid fractures 2.
- Proximal, dislocated, and unstable scaphoid fractures should be treated surgically, while non-displaced or minimally displaced fractures of the middle third of the scaphoid bone require a shorter period of immobilization with surgical treatment (2-4 weeks) than with conservative treatment (6-8 weeks) 2.
- The use of plaster casts that do not hinder elbow and thumb mobility yields healing rates similar to those obtained with the immobilization of both of these joints 2.
- Other, rarer types of carpal fractures must be managed on an individual basis, as the available evidence is limited to expert consensus 2, 3, 4.
Management and Outcomes
- The fundamental principles used by clinicians to choose appropriate stabilization and length of immobilization for carpal fractures are discussed in various studies 5, 6.
- The principles behind the progression of therapeutic intervention and the relation of progression to the stages of healing are emphasized 5.
- Carpal fractures can be complicated by concomitant damage to surrounding structures, chronic comorbidities, or delays in diagnosis, and treatment plans should be based on a review of the literature and an evidence-based approach to imaging studies 6.