Management of greater arc carpal fractures

Greater arc injuries are fracture dislocations that involve the perilunar carpal bones. The commonest of these injuries is the dorsal transscaphoid perilunate fracture dislocation. The recommended treatment for acute injuries is open reduction and Kirschner wire fixation of the scaphoid fracture through a dorsal midline approach. Stability to the midcarpal joint is thus provided and no further pins are needed. Established scaphoid nonunions are treated by bone grafting and Herbert screw fixation through a volar approach. Scaphocapitate fracture syndrome is treated by open reduction and pin fixation of the displaced capitate fragment through the dorsal approach. If the scaphoid is displaced it is also openly reduced and pinned.