How are triquetral fractures of the wrist diagnosed and treated?

Updated: Nov 22, 2019
  • Author: David M Lichtman, MD; Chief Editor: Harris Gellman, MD  more...
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Answer

The triquetrum is the most commonly fractured carpal bone. Isolated fractures are rare; most triquetral fractures are associated with other carpal injuries, such as perilunate transtriquetral dislocation. [56] Two types of triquetral fractures occur, dorsal cortical fractures and fractures through the triquetral body. Some authors have suggested that dorsal cortical fractures can be produced from avulsion fractures or impaction of the ulnar styloid when the wrist is forcibly dorsiflexed and ulnarly deviated. Isolated fractures of the body are usually the result of a direct blow to the ulnar wrist.

On examination of an acute fracture, tenderness, swelling, and (occasionally) ecchymosis are found. An associated loss of extension and ulnar deviation of the wrist is often present. In addition to routine radiographs, an oblique view in 30° of pronation often reveals a fracture. When the clinical suspicion of a fracture remains high in the absence of an obvious fracture on plain radiography, CT should be considered.

Dorsal cortical fractures may be treated with cast immobilization for 6 weeks. If un-united cortical fragments remain symptomatic, excision may be necessary. Triquetral body fractures are usually nondisplaced and heal well with cast immobilization for 6 weeks. When the triquetral body is displaced, ORIF may be required. To the authors' knowledge, no reports of avascular necrosis (AVN) of the triquetrum have been published.


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