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Purpose <p>To describe the epidemiology, injury mechanisms, diagnostic approach, management, and clinical outcomes of non-scaphoid carpal fractures, which are frequently overlooked or diagnosed late.</p> Methods <p>A retrospective review was conducted of patients with non-scaphoid carpal fractures treated at our institution between 2013 and 2020. Demographic data, fracture characteristics, time to diagnosis, treatment strategy, rehabilitation requirements, and clinical outcomes, including complications, were analyzed.</p> Results <p>76 patients with 86 fractures were included; 54 (71%) were male. The most commonly affected bones were the triquetrum (37%) and hamate (33%). Isolated fractures accounted for 89% of cases. Advanced imaging was frequently required, with CT performed in 53% and MRI in 7% of patients. The median diagnostic delay was 6 days (range: 1–40). Conservative treatment was used in 84% of cases. Surgical management was significantly more frequent in lunate (75%) and hamate fractures (25%) (<i>p</i> = 0.008). Surgically treated patients required rehabilitation more often than those managed conservatively (58% vs. 31%, <i>p</i> = 0.012). Functional range of motion (&gt; 40° flexion/extension) was achieved in 97% of patients. However, 16% developed chronic wrist pain, 8% reported prolonged soreness, and one patient developed reflex sympathetic dystrophy.</p> Conclusions <p>Although functional outcomes are generally favorable, diagnostic delays remain common in non-scaphoid carpal fractures, particularly involving the lunate and capitate. Advanced imaging improves diagnostic accuracy but is often requested in complex or delayed cases, reflecting an indication bias. Early recognition and appropriate management are crucial to reduce persistent pain and complications.</p>

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Non-scaphoid carpal fractures: lessons learned from a series of 86 cases

  • 期刊论文

  • 发表日期：

    2026年4月10日

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  • Susana Herrero Alonso,
  • Javier Fernández González-Cuevas

摘要

Purpose

To describe the epidemiology, injury mechanisms, diagnostic approach, management, and clinical outcomes of non-scaphoid carpal fractures, which are frequently overlooked or diagnosed late.

Methods

A retrospective review was conducted of patients with non-scaphoid carpal fractures treated at our institution between 2013 and 2020. Demographic data, fracture characteristics, time to diagnosis, treatment strategy, rehabilitation requirements, and clinical outcomes, including complications, were analyzed.

Results

76 patients with 86 fractures were included; 54 (71%) were male. The most commonly affected bones were the triquetrum (37%) and hamate (33%). Isolated fractures accounted for 89% of cases. Advanced imaging was frequently required, with CT performed in 53% and MRI in 7% of patients. The median diagnostic delay was 6 days (range: 1–40). Conservative treatment was used in 84% of cases. Surgical management was significantly more frequent in lunate (75%) and hamate fractures (25%) (p = 0.008). Surgically treated patients required rehabilitation more often than those managed conservatively (58% vs. 31%, p = 0.012). Functional range of motion (> 40° flexion/extension) was achieved in 97% of patients. However, 16% developed chronic wrist pain, 8% reported prolonged soreness, and one patient developed reflex sympathetic dystrophy.

Conclusions

Although functional outcomes are generally favorable, diagnostic delays remain common in non-scaphoid carpal fractures, particularly involving the lunate and capitate. Advanced imaging improves diagnostic accuracy but is often requested in complex or delayed cases, reflecting an indication bias. Early recognition and appropriate management are crucial to reduce persistent pain and complications.