(iii) Injuries of the carpus

Fractures of the carpus account for one-fifth of all hand fractures, although if scaphoid fractures are excluded, the remaining seven carpal bones amount to only 1.1% of all such fractures. Rarity renders these injuries a diagnostic challenge as, within the practice of a general orthopaedic surgeon, they are infrequently encountered and can be difficult to visualize on standard radiographs due to the complex three-dimensional nature of their anatomy and articulation.Cross-sectional imaging of all wrist injuries is not necessary or economically feasible and hence clues to the patient’s mechanism of injury, clinical examination, and plain radiographs must be sought in order that appropriate escalations of injury management ensue.Injuries to the carpus tend to occur in young active people of working age and hence missing or inadequately treating these fractures has potentially catastrophic implications to the patient, and to society as a whole. Prompt diagnosis and treatment may lead to faster recovery and may minimize long-term sequelae.This article seeks to give simple guidance to help the general orthopaedic surgeon to recognize, investigate and treat soft tissue and bony injuries relating to the carpal bones.