Fractures of the carpus, excluding the scaphoid

Carpal bone fractures comprise an important group of injuries that present difficulties in both diagnosis and treatment. These fractures may be missed for the following reasons: physician's low index of suspicion, the carpal bones' irregular contours and degree of overlap on radiographs making the fractures difficult to visualize, and the common occurrence of concomitant fractures of neighboring metacarpals, distal radius, or scaphoid, which misdirects the examiner. A high index of suspicion with careful clinical examination and elicitation of point tenderness is key to making the correct diagnosis (Fig. 14). Swelling, loss of motion, deformity, and crepitus are often minimal and are not reliable in distinguishing carpal fractures. Specific radiographic projections, tomograms, computerized tomographic scans, or bone scans are often required and should be considered in any wrist injury where the diagnosis is in question. A greater awareness of the fracture types, methods of diagnosis, and choices of treatment is essential for optimal management of these injuries.