13 patients who sustained high-energy crush or blast injury of the car
pal bones were reviewed after a mean follow-up period of 30 months. Th
ese complex injuries resulted in unusual disruptions of the distal car
pal row and adjacent metacarpals. Frequent involvement of the carpomet
acarpal (CM) joints and violation of the proximal carpal row were also
demonstrated. Nine were open injuries, with the majority accompanied
by significant soft tissue damage. Treatment included either closed re
duction or open reduction and Kirschner wire fixation, and soft tissue
procedures as indicated. In this series, the majority of the open inj
uries gave unfavourable functional results despite adequate carpal ali
gnment. Several cases had disastrous outcomes related to associated va
scular injuries. Closed injuries, on the contrary, followed a relative
ly benign course. Nevertheless, decreased grip strength persisted in b
oth groups For a long time. Patients with such a complex carpal injury
should expect a less favourable prognosis due to the severe nature of
the trauma.