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Triquetrum Fracture
From WikiSM
Contents
Other Names
- Triquetral Fracture
Background
- Triquetrum is the second most common carpal fracture behind Scaphoid[1]
- Accounts for 15% of all carpal fractures
Pathophysiology
- Most commonly do to fall on wrist with dorsiflexion and ulnar deviation
- Avulsion due to attachments of the radiotriquetral (dorsal radiocarpal) and triquetroscaphoid (dorsal intercarpal) ligaments
- Associated with
Risk Factors
- Unknown
Differential Diagnosis
Carpal Bone Fractures
- Scaphoid Fracture
- Lunate Fracture
- Triquetrum Fracture
- Pisiform Fracture
- Trapezium Fracture
- Trapezoid Fracture
- Capitate Fracture
- Hamate Fracture
Differential Diagnosis Wrist Pain
- Fractures
- Dislocations
- Wrist Dislocation (Radiocarpal and/or Ulnocarpal)
- Carpometacarpal Joint Dislocation
- Distal Radioulnar Joint Dislocation
- Lunate Dislocation
- Perilunate Dislocation
- Instability & Degenerative
- Tendinopathies & Ligaments
- Neuropathies
- Pediatric Considerations
- Distal Radial Epiphysitis (Gymnast's Wrist)
- Torus Fracture
- Arthropathies
- Cartilage
- Vascular
- Other
Clinical Features
- General: Physical Exam Wrist
- Swelling, bruising, pain at distal wrist, typically over ulnar side
- Pain with direct palpation of triquetrum
Evaluation
Radiographs
- Standard Radiographs Wrist
- 3 view radiographs often sufficient
- Pooping Duck sign: dorsal cortical fractures
MRI
- Useful for palmar cortical fractures
- Can evaluate for other soft tissue pathology
CT
- Useful for assessing fracture fragments, extend of collapse, pre-operative planning
Classification
- Dorsal cortical fractures[2]
- >90%
- Mechanism: Avulsion, shearing, impaction
- Body fractures
- Second most common
- Multiple subtypes
- Palmar cortical fractures
- Mechism: avulsion, shering force
- Higher risk of instability
Management
Nonoperative
- Indications:
- Dorsal cortical fracture without carpal instability
- Nondisplaced body fractures
- Palmar cortical fracture without carpal instability
- Cast: Short Arm Cast
- Immobilize for 4-6 weeks
Operative
- Indications:
- Dorsal cortical fracture with carpal instability
- Displaced body fractures
- Palmar cortical fracture with carpal instability
Return to Play
- 6 to 8 weeks
Complications
- Nonunion
- Carpal Instability
- Pisotriquetral arthritis
See Also
- Internal
- External
- Sports Medicine Review Wrist Pain: https://www.sportsmedreview.com/by-joint/wrist/
References
- ↑ Suh N, Ek ET, Wolfe SW. Carpal fractures. J Hand Surg Am. 2014 Apr;39(4):785-91; quiz 791. doi: 10.1016/j.jhsa.2013.10.030. Review. PubMed PMID: 24679911.
- ↑ https://www.orthobullets.com/hand/322147/triquetrum-fracture