The wrist is made up of 10 bones consisting of two bones of the forearm and eight carpal bones. The bones of the forearm are the radius and the ulna. The carpal bones are scaphoid, pisiform, trapezium, lunate, trapezoid, capitate, triquetrum, and hamate. The bones of wrist and hand collectively form the wrist.
The scaphoid bone is joined with both rows of carpal bones. The lunate bone is central join of carpal bones. The short intercarpal ligaments tie carpal bones with one another; for example, triquitrolunate and the scapholunate.
What is Carpal Fracture?
Carpal fracture(1) is a medical condition where a carpal bone gets fractured. This fracture often is as a result of trauma due to falling on the wrist directly or on outstretched hands. There are chances that bones in the carpal region get dislocated due to the high impact injury due to a fall. Road accidents could also cause dislocation of carpal bones. These fractures are quite acute and it is very hard to diagnose them. Diagnosing and treating these fractures is imperative failure of which may cause permanent damage.
Types of Carpal Fracture
Some Of The Types Of Carpal Fractures Are As Follows:
- Scaphoid Fracture: It is the fracture of the scaphoid bone(2) in the wrist. This type of fracture can occur frequently and is quite common. It can be further categorized into distal pole fracture, proximal pole fracture, or tubercle fracture depending on the site of injury.
- Triquetral Fracture: This is a fracture of triquetrum in the wrist. After scaphoid fracture, this is a fracture that is quite common.
- Trapezial Fracture: It is the fracture of the trapezium in the wrist. This fracture comes third in the list of common wrist fractures.
- Capitate Fracture: This is a fracture of capitate. These fractures are very rare as they are the most protected bones of the wrist.
Causes of Carpal Fracture
These Fractures Can Be As A Result Of Numerous Injuries, Some Of Which Include:
- Falling on outstretched hand to avoid falling.
- Most common cause is contact sports where there are frequent collisions amongst players.
- Repetitive and frequent use of the wrist can also cause fractures of the wrist. This is frequent in those individuals involved with physical labor.
- Motorcycle accidents.
- Car crashes.
- Direct trauma to wrist.
- Contact sports.
- Crush injuries.
Symptoms of Carpal Fracture
Some Of The Symptoms Of Carpal Fracture Are
- Acute pain on wrist near the thumb after a fall or trauma.
- Aggravation of pain with wrist movements.
- Tenderness with touch.
- Pain around the injured bone spreading to other parts of the wrist.
- Decreased range of motion of the wrist.
- Malalignment of the wrist.
- A numb and tingly feeling suggesting a nerve injury.
- Exacerbation of pain with gripping etc.
- Stiff movements of thumb and digits.
Treatment For Carpal Fracture
It is imperative that such fractures are treated as early as possible failure of which may result in conditions like bone misalignment, which can impair usage of wrist quite significantly. If treated early, it can also help with issues like stiffness and pain and help in stabilizing them.
Nonsurgical Treatment For Carpal Fracture
- Conservative treatment for these fractures depends on factors such as the type, cause, and the age of the individual. Following are some of modalities of treatment.
- Application of a cast in the case of a nondisplaced fracture despite injury in order to support it till it gets completely healed.
- In cases of displacement impairing use of the arm effectively, it may be treated with reduction. This includes nonsurgical reduction of the bone using local anesthesia or even without it to restore normal alignment. This modality is called closed reduction. Once the bone gets back to its usual position, the wrist may be casted or splinted.
Surgical Treatment of Carpal Fracture
- Surgical procedure is needed for acute cases of fractures where the misalignment has reached a point where it is difficult to treat conservatively. For example, numerous fragments of bones at the site of the fracture requiring them to be put together until they get united. This method of realignment is called Open Reduction.
- Surgery is done by creating an incision to expose the fracture so as to get it back to its usual position. This sometimes requires usage of metal pins, screws, and/or external fixator.(3)
- Bone grafting is needed in cases where the bone breaks into numerous fragments to allow it to heal. In bone grafting, there is placement of a new bone to promote healing. Bone grafting increases bone production which hastens healing of the bone.
- Any sort of surgery has its inherent risk which in this case is infection, bleeding, injury to the neurovascular structures, or the hardware fails.
Exercises for Carpal Fracture
Stretching/strengthening exercises are imperative when the patient is recovering for ranges of motion and normal functioning of wrist.
Exercises for Stretching
Flexion: This is performed with the wrist bent in a forward position till there is no sensation of pain. It should be done for five seconds. It should be performed in twice, 15 times each.
Extension: In this exercise, the wrist is bent backwards till there is a pain free stretch and held in this position for five seconds. This should also be performed twice, 15 times each.
Side-to-Side: In this exercise, the wrist is moved from one side to the other until there is no pain. It should be done for five seconds in each direction.
Wrist Extension Stretching: In this exercise, the elbow is kept straight and the fingers are placed flat on an object such as table and the palms of the hand should be facing down. Now, the body should be moved forward so that its weight is moved in the forward direction for at least 20 seconds.
Stretching with Wrists Flexed: In this exercise, the elbow is kept straight and the hand is placed on an object and the palms should be facing up and fingers should point towards the body. Now, bend towards the opposite direction of the object and stay in the same position for half a minute.
Pronation and Supination of Forearm:(4) In this exercise, the elbow is bent at a right angle. The palms should be rotated upwards for five seconds. Now, slowly rotate palm in opposite direction for five seconds. It should be done thrice for 10 times but one needs to make sure that symptoms are not aggravated.
Wrist Flexion: In this exercise the person can hold the handle of a hammer with palms facing in the upward direction. Then, the wrist should be bent upwards very slowly. Now, the weight should be slowly decreased and then return to starting position. It should be performed in twice, 15 times each and the weight should be increased slowly.
Wrist Extension: In this exercise the person can hold a handle of a hammer with palms facing in the downward direction. Then, the wrist should be bent upwards very slowly. Now, the weight should be slowly decreased and then return to the starting position. It should be performed twice, 15 times each and the weight should be increased slowly.
Tennis Ball Squeeze: In this exercise, a spongy ball is held and squeezed the hardest possible way, without aggravating the pain, for five seconds and then released. This may be repeated 10 times but one should make sure that the symptoms are not aggravated.
Resistance Band Wrist Flexion: In this exercise, a resistance band is used on the fingers with palm facing upwards. The elbow is kept at the side of the body and bent at a right angle. The forearm needs to be supported with the help of the other hand. Slowly, the fingers and wrist are curled upwards near the resistance band to make the muscles of the forearm tight. It should be done in 3 sets of 10.
Resistance Band Wrist Extension: In this exercise, a resistance band is used on the fingers with palm facing downwards. The elbow is kept at the side of the body and bent at a right angle. The forearm needs to be supported with the help of the other hand. Slowly, the fingers and wrist are curled upwards near the resistance band to make the muscles of the forearm tight. It should be done in 3 sets of 10.
Resistance Band Radial Deviation: In this exercise, a resistance band is used on the fingers with the thumb facing upwards. The elbow is kept at the side of the body and bent at a right angle. The forearm needs to be supported with the help of the other hand. Slowly, the fingers and wrist are curled upwards near the resistance band to make the muscles of the forearm tight. It should be done in 3 sets of 10.
Investigations for Carpal Fracture
A comprehensive history and physical assessment is required for confirmatory diagnosis. A detailed neurovascular examination is performed for assessment of injuries to the nerves or vessels. Radiological studies like x-rays are very useful to know the exact location of the fracture. Other studies may be CT and MRI.