Carpal Bone Injuries Workup

  • Author: Bryan C Hoynak, MD, FACEP, FAAEM; Chief Editor: Sherwin SW Ho, MD   more...
 
Updated: Feb 28, 2010
 

Laboratory Studies

  • No laboratory studies are indicated in cases of isolated wrist injury. However, erythrocyte sedimentation rate analysis can be helpful for monitoring the degree of inflammation involved with a chronic wrist problem.
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Imaging Studies

  • The majority of wrist fractures can be assessed adequately with good-quality AP and lateral radiographic images.[9] The palmar slope of the articular surface of the distal radius is appreciated on a lateral x-ray film of the wrist. A slope of 11 º is normal.
  • For distal radius fractures, measure the palmar slope to assess the degree of angulation. Determine whether the fracture is intra-articular, and note the presence of any step-off at the articular surface. The ulnar styloid is chipped in approximately 60% of all patients with this fracture.
  • For scaphoid fractures, the fracture may be at the wrist, tuberosity, or proximal pole. If a scaphoid fracture is strongly suggested, a posteroanterior view of the scaphoid with the wrist in ulnar deviation may distract the fragments and make the fracture more apparent.
  • A bone scan or magnetic resonance imaging study may be necessary to detect occult fractures that may not be visualized on plain radiographs.[10, 11]
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Contributor Information and Disclosures
Author

Bryan C Hoynak, MD, FACEP, FAAEM  Associate Clinical Professor of Emergency Medicine, University of California at Irvine School of Medicine; Director of Emergency Services, Chairman of Division of Emergency Medicine, Placentia-Linda Hospital

Bryan C Hoynak, MD, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American Burn Association, American College of Emergency Physicians, American College of Surgeons, and American Heart Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Janos P Ertl, MD  Assistant Professor, Department of Orthopedic Surgery, Indiana University School of Medicine; Chief of Orthopedic Surgery, Wishard Hospital

Janos P Ertl, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, Hungarian Medical Association of America, and Sierra Sacramento Valley Medical Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Russell D White, MD  Professor of Medicine, Director of Sports Medicine Fellowship Program, Medical Director, Sports Medicine Center, Head Team Physician, University of Missouri-Kansas City Intercollegiate Athletic Program, Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center Lakewood

Russell D White, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Family Physicians, American Association of Clinical Endocrinologists, American College of Sports Medicine, American Diabetes Association, and American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

Jon B Whitehurst, MD  Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital

Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America

Disclosure: Nothing to disclose.

Chief Editor

Sherwin SW Ho, MD  Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago

Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America

Disclosure: Breg, Inc. Consulting fee Consulting; Biomet, Inc. Consulting fee Consulting; GMV, Inc. Arthroscopy Simulator Evaluation and teaching; Smith and Nephew Grant/research funds Fellowship funding; DJ Ortho Grant/research funds Course funding

References

  1. Hoppenfeld S. Physical Examination of the Spine and Extremities. Norwalk, Conn: Appleton & Lange; 1976.

  2. Simon RR, Koenigsknecht SJ. Orthopaedics in Emergency Medicine. 2nd ed. New York, NY: Appleton-Century-Crofts; 1982.

  3. Papp S. Carpal bone fractures. Orthop Clin North Am. Apr 2007;38(2):251-60, vii. [Medline].

  4. Lohan D, Cronin C, Meehan C, et al. Injuries to the carpal bones revisited. Curr Probl Diagn Radiol. Jul-Aug 2007;36(4):164-75. [Medline].

  5. Ezquerro F, Jiménez S, Pérez A, et al. The influence of wire positioning upon the initial stability of scaphoid fractures fixed using Kirschner wires A finite element study. Med Eng Phys. Jul 2007;29(6):652-60. [Medline].

  6. Vigler M, Aviles A, Lee SK. Carpal fractures excluding the scaphoid. Hand Clin. Nov 2006;22(4):501-16; abstract vii. [Medline].

  7. Beeres FJ, Hogervorst M, Den Hollander P, Rhemrev SJ. Diagnostic strategy for suspected scaphoid fractures in the presence of other fractures in the carpal region. J Hand Surg [Br]. Aug 2006;31(4):416-8. [Medline].

  8. Steinmann SP, Adams JE. Scaphoid fractures and nonunions: diagnosis and treatment. J Orthop Sci. Jul 2006;11(4):424-31. [Medline].

  9. De Filippo M, Sudberry JJ, Lombardo E, et al. Pathogenesis and evolution of carpal instability: imaging and topography. Acta Biomed. Dec 2006;77(3):168-80. [Medline]. [Full Text].

  10. Nanno M, Patterson RM, Viegas SF. Three-dimensional imaging of the carpal ligaments. Hand Clin. Nov 2006;22(4):399-412; abstract v. [Medline].

  11. You JS, Chung SP, Chung HS, et al. The usefulness of CT for patients with carpal bone fractures in the emergency department. Emerg Med J. Apr 2007;24(4):248-50. [Medline].

  12. DePalma AF. The Management of Fractures and Dislocations. 2nd ed. Philadelphia, Pa: WB Saunders; 1970.

  13. Tintinalli JE, Ruiz E, Krome RL, eds. Emergency Medicine: a Comprehensive Study Guide. 4th ed. New York, NY: McGraw-Hill; 1996.

  14. Rosen P, Barkin RM, Braen GR, et al, eds. Emergency Medicine: Concepts and Clinical Practice. 4th ed. St. Louis, Mo: Mosby-Year Book; 1998.

  15. Plint AC, Perry JJ, Correll R, Gaboury I, Lawton L. A randomized, controlled trial of removable splinting versus casting for wrist buckle fractures in children. Pediatrics. Mar 2006;117(3):691-7. [Medline]. [Full Text].

 
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