Evaluation of Associated Carpal Bone Fractures in Distal Radial Fractures

The wrist is a complex joint consisting of bony structures, including the distal radius, distal ulna, and eight carpal bones and a ligament complex that divides extrinsic and intrinsic ligaments. Therefore, the prognosis of wrist injuries can be affected by soft tissue injuries as well as fractures. 1-4) Distal radial fractures (DRFs) are common injuries that occur in the upper limb and are treated using various methods, including closed reduction and cast immobilization, percutaneous K-wire fixation, external fixation, intramedullary fixation, and open reduction and internal fixation. Various clinical results and complication Background: The purpose of this study was to investigate the frequency and distribution of associated carpal bone fractures (CBFs) in distal radial fractures (DRFs). Methods: Three hundred and thirteen patients who underwent surgical treatment for DRFs between March 2007 and January 2010 were reviewed retrospectively. In this study, 223 patients who had preoperative computed tomography (CT) were included. We investigated the frequency and distribution of associated CBFs on CT scans. The relationship between the frequency of associated CBFs and patient factors such as age, gender, body mass index, and the mechanism of injury was assessed. Results: CBFs were complicated in 46 of 223 DRFs (20.9%). The distribution of CBFs was 23 cases in the triquetrum, 16 in the lunate, 12 in the scaphoid, five in the hamate, and four in the pisiform. Among the 46 cases, a fracture of one carpal bone occurred in 36 cases, two in seven cases, three in two cases, and four in one case. In 10 of the 46 cases, associated CBFs occurred in more than two carpal bones. No significant differences were observed for age, sex, body mass index, or the mechanism of injury be tween patients with DRFs and CBFs and those without CBFs. Conclusions: Because CBFs that mainly occur in the proximal carpal row are complicated in DRFs at a relatively high frequency, assessment of carpal bones using CT scans is beneficial.