Triquetrum fracture: Difference between revisions
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*3rd most common carpal bone injury (following scaphoid and lunate fractures)<ref name="Hand and wrist emergencies">German C. Hand and wrist emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013.</ref> | *3rd most common carpal bone injury (following scaphoid and lunate fractures)<ref name="Hand and wrist emergencies">German C. Hand and wrist emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013.</ref> | ||
*Mechanism of injury | *Mechanism of injury | ||
**Avulsion | **Avulsion fracture: Twisting motion of hand that is suddenly resisted | ||
**Body | **Body fracture: Direct trauma (commonly accompanied by lunate/perilunate dislocations) | ||
==Clinical Features== | ==Clinical Features== | ||
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==Evaluation== | ==Evaluation== | ||
*Hand x-ray | |||
**PA - best for seeing nondisplaced fracture | |||
**Lateral/oblique in partial pronation - best for seeing avulsion fracture (tiny flake of bone on dorsum of triquetrum) | |||
[[File:Triquetrum_Fracture.jpg|thumb|Avulsion fracture of triquetrum]] | [[File:Triquetrum_Fracture.jpg|thumb|Avulsion fracture of triquetrum]] | ||
==Management== | ==Management== | ||
{{General Fracture Management}} | |||
===Avulsion fracture=== | ===Avulsion fracture=== | ||
*Wrist splint ([[Forearm volar splint]]) x1-2wks | *Wrist splint ([[Forearm volar splint]]) x1-2wks | ||
===Body fracture=== | ===Body fracture=== | ||
*Stable: cast x 6wks | |||
*Unstable (>1mm displacement): May require internal fixation | |||
==Disposition== | ==Disposition== | ||
* | *Discharge with orthopedic surgery follow-up | ||
==See Also== | ==See Also== | ||
Latest revision as of 04:47, 18 September 2019
Background
- 3rd most common carpal bone injury (following scaphoid and lunate fractures)[1]
- Mechanism of injury
- Avulsion fracture: Twisting motion of hand that is suddenly resisted
- Body fracture: Direct trauma (commonly accompanied by lunate/perilunate dislocations)
Clinical Features
- Localized tenderness over dorsum of wrist in area immediately distal to ulnar styloid
- Evaluate for deep branch of ulnar nerve impairment[1]
Differential Diagnosis
Carpal fractures
- Scaphoid fracture
- Lunate fracture
- Triquetrum fracture
- Pisiform fracture
- Trapezium fracture
- Trapezoid fracture
- Capitate fracture
- Hamate fracture
Evaluation
- Hand x-ray
- PA - best for seeing nondisplaced fracture
- Lateral/oblique in partial pronation - best for seeing avulsion fracture (tiny flake of bone on dorsum of triquetrum)
Management
General Fracture Management
- Acute pain management
- Open fractures require immediate IV antibiotics and urgent surgical washout
- Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention
- Consider risk for compartment syndrome
Avulsion fracture
- Wrist splint (Forearm volar splint) x1-2wks
Body fracture
- Stable: cast x 6wks
- Unstable (>1mm displacement): May require internal fixation
Disposition
- Discharge with orthopedic surgery follow-up