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Abstract
The wrist joint is a complicated structure composed of many bones and ligaments. Therefore, understanding the anatomy and the biomechanics of the wrist is important in order to administer proper treatment for patients. To easily understand the complicated structure, there were many trials to unite the complicated structure with a simple group such as the carpal row concept and the carpal column concept. Movement and load transfer along the wrist joint occurs with balanced action between carpal bones. To evaluate this static equilibrium, measuring tools such as carpal height ratio are used. When wrist flexion/extension occurs, each carpal row moves synchronously with action of the scaphoid. In contrast with flexion/extension, when wrist radial deviation/ulnar deviation occurs, the proximal carpal row moves in the sagittal plane, instead of the coronal plane. Recently, the dart throwing motion which occurred from the position of dorsiflexion with radial deviation to volar flexion with ulnar deviation is considered the main movement of the wrist joint.
Figures and Tables
Fig. 1
Row concept of carpal bones. The joints with adjacent bones which do not have gross motion, considered as a single motor unit. The proximal row is composed of scaphoid, lunate, and triquetrum. The distal row is composed of trapezium, trapezoid, capitate, and hamate.
Fig. 2
Column concept of carpal bones. The lateral column is composed of scaphoid, trapezium, and trapezoid. The middle column is composed of lunate and capitate, and the medial column is composed of triquetrum and hamate.
Fig. 3
Scaphoid nonunion advanced collapse. Left wrist simple radiograph of a 53-year-old man. The advanced degenerative changes are evident around the radiocarpal joint with scaphoid nonunion.
Fig. 4
Carpal height ratio. (A) Carpal height ratio is calculated by dividing carpal height (b) with length of the 3rd metacarpal bone (a). (B) A simple radiograph of measurement of carpal height ratio.
Fig. 5
Movement of carpal rows during radial deviation and ulnar deviation. (A) During radial deviation of the wrist joint, the proximal carpal row is flexed volarly and deviated radially, and the distal carpal row is flexed dorsally. (B) During ulnar deviation of the wrist joint, the proximal carpal row is flexed dorsally and deviated ulnarly, and the distal carpal row is flexed volarly.
Fig. 6
Computed tomography based three dimensional kinematic comparison of the scaphoid during dart throwing motion between distal radius fracture malunion and contralateral normal side. (A) Radial deviation and dorsal tilt position. (B) Mid-range of dart throwing motion. (C) Ulnar deviation and volar tilt position. The orientations of the helical axes (bold line of each figure) of the scaphoid are different between two sides.
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