How to diagnose and treat fractures of the lunar bone, hook bone, most horn and other carpal bones?

1. Lunar bone fracture

Crescent fractures are rare fractures of the wrist and are prone to complicated by ischemic necrosis of the lunar bone, also known as Killnbck fractures.

(1) Diagnosis

It is commonly caused by injury caused by palm supporting the ground or pushing a heavy object with a strong force, and after injury, wrist pain and weakness, swelling of the back of the wrist, limited wrist joint mobility, obvious tenderness in the lunar bone area, and obvious percussion pain along the third metacarpal bone. X-rays may show fractures.

(2) Treatment

1． Fresh lunar fractures can be fixed externally with a short-arm cast for 12 weeks.

2． Old moon bone fractures complicated by ischemic necrosis can be treated with a surgical replacement of a silica rubber artificial joint with a lunar bone removal silicone rubber, ulna elongation, or radius shortening surgery. Advanced complicated by severe osteoarthritis may also be removed with proximal carpal bone removal.

2. Hook bone fracture

Hook fractures are mostly avulsive fractures, commonly found in the hook of the hook bone, and the local swelling, pain, and tenderness are obvious after injury. Carpal tube x-rays can mostly show the fracture site, and a few clinical symptoms are obvious.

Patients with negative x-rays may have a wrist CT scan with prayer-like hands during the examination, which can help with the diagnosis.

Treatment is done with a cast tubule for 4 to 6 weeks.

Third, most of the horn bone fractures

Most of the angular bone fractures are avulsive fractures caused by wrist dorsal extension, with local swelling and pain after injury, and X-ray examination can confirm the diagnosis. Palmer divides it into two types according to the site of the fracture:

Type I: Fracture of the base of the crest of most of the horn bone, which heals easily after external fixation by cast.

Type II: Avulsive fracture of the tip of the crest of most of the horn bone, which is not easy to heal after external fixation.

4. Other wrist bone fractures

Other carpal bone fractures are mostly avulsive fractures, which are generally of no clinical significance, have little impact on wrist function, and only need to be externally fixed in the tubular cast of the forearm for 4 to 6 weeks. Some wrist bone fractures, such as skull neck fractures, should be tightly fixed. In the small number of fractures with difficulty in reducing, incision reduction and internal fixation may be considered. In patients with advanced complicated osteoarthritis and affecting joint function, interoskeletal fusion is considered.

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