Fractures of the carpal bones other than lunate and navicular

Injuries to the carpals and their ligaments are difficult to diagnose unless one utilizes special X-ray techniques based upon a careful history of the injury and examination for tender points and painful joints. Use of only standard X-rays and cursory examinations caused many injuries to be missed in earlier years. Many fractures resolve with simple splinting or casting, but many do not, and late sequelae are now being diagnosed more commonly than in the past. Localization of pathologic conditions by diagnostic injections of local anesthesia or arthrography (or both) is very helpful. Salvage may require excision of fragments, exostoses, reconstruction of ligaments, or local arthrodesis.