Triquetrum fracture

Background

• 3rd most common carpal bone injury (following scaphoid and lunate fractures)
• 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

Differential Diagnosis

Carpal fractures

AP view

• 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)

Avulsion fracture 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

See Also

• Carpal fractures