Carpal Bone Fx Summary

Carpal Bone Mechanism of Injury Examination Initial ED Management
Scaphoid Fall on outstretched hand Snuffbox tenderness. Pain with radial deviation and flexion Short arm, thumb spica, in dorsiflexion with radial deviation
Triquetrum Avulsion fracture - twisting of hand against resistance or hyperextension Tenderness at the dorsum of the wrist, distal to the ulnar styloid Short arm, sugar tong splint
Body fracture - direct trauma    
Lunate Fall on outstretched hand Tenderness at shallow indentation of the mid-dorsum of the wrist, ulnar and distal to Lister tubercle Short arm, thumb spica splint
Trapezium Direct blow to thumb; force to wrist while dorsiflexed and radially deviated Painful thumb movement and weak pinch strength Short arm thumb spica splint
Snuffbox tenderness  
Pisiform Fall directed on the hypothenar eminence Tender pisiform, prominent at the base of the hypothenar eminence Short arm, volar splint in 30 degrees of flexion and ulnar deviation
Hamate Interrupted swing of a golf club, bat, or racquet Tenderness at the hook of the hamate, just distal and radial to the pisiform Short arm, volar wrist splint with fourth and fifth metacarpal joints in flexion
Capitate Forceful dorsiflexion of the hand with radial impact Tenderness over the capitate just proximal to the third metacarpal Short arm, volar wrist splint
Trapezoid Axial load onto the index metacarpal Tenderness over the radial aspect of the base of the index metacarpal Short arm thumb spica splint