Carpal fractures in athletes

A review of the literature shows that 3% to 9% of all athletic injuries occur to the hand or wrist. Also, hand and wrist injuries are more common in pubescent and adolescent athletes than adults. Although knee and shoulder injuries are more common athletic injuries, an injury to the hand or wrist significantly can impair the athlete's ability to throw or catch a ball, or swing a bat or racquet. A college football player trains year round for just 11 or 12 hours of playing time. An athletic injury that occurs during the season can have profound consequences for the athlete's career and emotions. When defining a management plan for a particular wrist athletic injury, the time to heal the injury and the time to rehabilitate fully must be considered. The athlete must be informed fully of the length of recovery. The continued advancement of fixation methods and techniques are diminishing fracture morbidity considerably. Small-cannulated compression screws that provide rigid fixation can be inserted with decreased surgical dissection, thus preserving critical vascular supply and promoting accelerated healing and earlier rehabilitation. The arthroscope as a valuable adjunct in the management of wrist fractures was virtually unheard of years ago, but is now common. The ability to arthroscopically guide a cannulated compression screw to stabilize a scaphoid fracture without a formal open volar approach can reduce surgical morbidity significantly and allow the athlete to return to competition more quickly. Mechanisms of injury that cause osseous fractures of the wrist are fairly high energy. A high index of suspicion for associated soft tissue injuries should be kept in mind when fractures of the wrist are identified. The wrist is composed of eight carpal bones tightly interwoven with each other by intrinsic and extrinsic wrist ligaments. The management of carpal fractures depends on prompt diagnosis, stable and anatomic alignment of the involved carpal bone, protective immobilization of the injury, and thorough rehabilitation. Displaced fractures of the hook of the hamate, trapezial ridge fractures, and comminuted pisiform fractures are managed best by early excision to promote uncomplicated recovery and early return to sport. For most athletes, return to competition can be expedited safely with the use of padded gloves and custom playing splints or casts. The sports medicine physician always must put the athlete's safety first when deciding the appropriate time for return to competition.