Triquetrum fracture
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
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
References
- 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.
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