Fractures of the Carpal Bones

Fractures can occur in all eight carpal bones. Although the pisiform bone is considered a sesame bone and “not a true carpal bone” by some authors, we still include it in this discussion. The radial column is most affected, especially the scaphoid. Standard X-rays are still the primary technique to evaluate carpal bone status. However, it is fairly well known that about 33% of all carpal bone fractures are missed and that the distribution changes a lot when cross-sectional imaging is used. Moreover, MRI has a very high sensitivity for detecting fractures in general due to its additional sensitivity to signal changes. For scaphoid fractures, MRI is even considered the gold standard, mainly to evaluate avascular necrosis of the proximal pole. Cross-sectional CT imaging will also visualise most fractures, but MRI has the added advantage of not requiring radiation. Both CT and MRI are not obstructed by plaster. However, in the acute phase, access to CT is easier and can often reveal unexpected fractures and dislocations.