How to manage triquetrum and hamate fractures in unusual patterns. Lateraloblique in partial pronation best for seeing avulsion fracture tiny flake of bone on dorsum of triquetrum. The triquetral ossification center often precedes the lunate 1. Fractures of the distal radius are the most common fracture in adults and are typically caused by a fall on the outstretched hand. They result from impingement of the ulnar styloid process against the dorsal surface of the triquetrum. The injuries were acquired due to the same trauma mechanism, in two separate accidents, only 9 h apart of each other.
Triquetrum fractures represent the second most common form of carpal bone fractures, far behind those of the scaphoid 1, 4. Triquetrum fracture introduction the triquetrum bone is one of the small bones that make up the carpus. The management of carpal fractures depends on prompt diagnosis, stable and anatomic alignment of the involved carpal bone, protective immobilisation of the injury, and careful rehabilitation. Treatment for a broken bone follows one basic rule. It differs from an avulsion fracture of the triquetral corner, which is regarded as ligamentous injury only.
Hierarchical classifications of closed fracture of triquetral cuneiform bone of wrist. Diagnosis ankle fractures usually result from torsional forces and present typically with tenderness, swelling, deformity and inability to weightbear. The importance of proper roentgenograms in ulnar sided wrist pain. Adequate reduction is verified by palpation for stepoffs along the dorsal and radial surfaces. A sudden, direct impact is the most common cause, resulting in wrist pain on the little finger side. The pisiform overlies the triquetrum in the ap and oblique views and tends to obscure the fracture white arrows. Disease ontology obo open biomedical ontologies closed fracture of carpal bone, unspecified. Triquetral fracture with associated pisiform subluxation ncbi. How to manage triquetrum and hamate fractures in unusual. Triquetral chip fractures are treated symptomatically with 23 weeks of immobilization if discomfort becomes significant.
May 10, 2018 triquetral fractures happen when you injure one of the small bones in your outer wrist called the triquetrum. Well go over what this type of fracture feels like and some of its common causes. The 3dimensional alignment of the carpal bones should be intact to ensure functional integrity of the hand. However, beware the nondisplaced ankle fracture presenting postinjury with minimal swelling and no deformity. Jan 15, 2018 after a visit from the doctor, or hearing a friend say that they have a triquetral fracture, you probably want to know what that means. Fractures are usually avulsions from the dorsal surface. More difficult fractures may require reproduction of the fracture deformity prior to reduction in order to mobilise the fracture site. Initial radiography showed a right triquetral fracture. Triquetrum fractures are especially common amongst those who play sports.
Triquetral fractures are the second most common carpal fracture. Triquetral fractures are carpal bone fractures generally occuring on the dorsal surface of the triquetrum. The triquetral may be fractured by means of impingement from the ulnar styloid, shear forces, or avulsion from strong ligamentous attachments. A triquetral bone is fractured less frequently when compared to the fractures of the scaphoid and lunate bones of the same area. Current case shows an unfortunate occurrence of a bilateral triquetral fracture in one patient. Diagnosis and management of scaphoid fractures american. We all know that there are different kinds of breaks you can get when injured. Can be due to many things, post fracture joint issues, things that have nothing to do with the actual fracture such as arthritis or tendonitis and some things that overlap, a careful followup exam and good follow up xrays may help sort this out. Fractures of the body of the triquetral bone are the second most common carpal fractures, and these fractures can be missed on plain xray. Carpal bone fractures comprise upwards of 8 percent of hand fractures.
A lateral view of the hand is typically required for diagnosis. Avulsion injuries of the hand and wrist radiographics. We herein present a case of right triquetral fracture with associated pisiform and flexor carpi ulnaris subluxation in a 29yearold man. Triquetrum fractures are the second most common carpal fractures.
General overviews of wrist pain and carpal fractures, as well as topics devoted to other specific carpal fractures in adults, are presented separately. Pisotriquetral arthrosis after triquetral malunion. The mechanism of injury is often a fall with the hand in hyperextension and ulnar deviation. Although nonunion of triquetral body fractures is rare, such cases can lead to considerable disability. Simultaneous bilateral triquetral fractures, acquired in. The following list attempts to classify closed fracture of triquetral cuneiform bone of wrist into categories where each line is subset of the next. The objective of our study was to report the mri findings in dorsal fractures of the triquetrum, with an emphasis on dorsal carpal ligament injuries. Hand xray pa best for seeing nondisplaced fracture. Let us go over what a triquetral fracture is for more. Clinical presentation includes localized tenderness and swelling. During radial wrist deviation, it also articulates with the capitate.
Closed fracture of triquetral cuneiform bone of wrist. Triquetrum fractures are the second most common carpal fractures after scaphoid. Introduction the pisiform is a sesamoid bone in the flexor carpi ulnaris tendon. Triquetral fractures are the second most common carpal fractures with a prevalence of 18.
Although conservative treatments including splinting, nonsteroidal antiinflammatory drugs, and local steroid injections were recommended, the patient desired immediate surgical treatment. The diagnosis of pisotriquetral arthrosis after triquetral malunion was made, but nonunion of the triquetrum could not be ruled out completely. Breaks for the fp to fix deepak patel, md, faafp, facsm activity disclaimer the material presented here is being made available by the american academy of family. Key words carpal fracture, hamate, lunate, trapezium, triquetrum. Pdf nonunion of the triquetrum with pseudoarthrosis. Nondisplaced triquetral fractures usually heal well, without complication.
Triquetral fracture the triquetrum is the second most commonly fractured carpal scaphoid is first. Fractures to bones of the proximal carpal rowcomprising the scaphoid, lunate, triquetrum and pisiform bonesare most frequent. Offer surgical and nonsurgical treatment options for each carpal fracture. However they are seldom encountered due to their clinical symptoms and since they cause less functional disability. Most transverse fractures of the triquetrum are treated with casts. The majority of fractures are dorsal ridge fractures, which occur at the dorsal aspect of the triquetrum, fig 8. Offensive lineman injures wrist, team mate falls on top of him. The energy of applied force determined the severity of the fracture. Carpal fractures scott wolfe md upper extremity surgeon. This study examines triquetral fracture data from six hospital centres between 2009 and 2018. Intraarticular fracture of the distal part of the triquetrum within the. Triquetral fractures triquetral fractures are the second most common isolated carpal fracture after scaphoid fractures about 15% figs.
They can be misdiagnosed as softtissue injuries by consid\ ering the similar localization of pain and prolonged symptoms. Once symptoms resolve or become less significant, rangeofmotion rom exercises can be initiated. Triquetral fracture with associated pisiform subluxation smj. Treatment of triquetrum fractures depends mainly on their specific type but literature results are sparse and. Injuries of the hand and wrist are frequently encountered in radiology. Pisiform fracture an overview sciencedirect topics. A small portion of the bone may be chipped off, or the fracture. Chip, flake, traction, or avulsion fractures of the dorsal aspect of the triquetrum often do not unite and may form a permanent ossicle. The triquetrum is the second most common carpal fracture after the scaphoid, representing to 28 percent of all carpal bone injuries. The fracture is reduced by applying dorsal pressure to the distal fragment, and is milked back into position. Most triquetral fractures result from falls from standing height onto the outstretched hand 1, 4. Background digital and hand fractures are seen in many settings and more commonly in situations involving machinery and heavy labor. Introduction summary about significance of fracture including epidemiology.
It is one of the eight small carpal bones in the wrist and the second most commonly fractured carpal. The patient was referred to an orthopaedic surgeon who recommended nonoperative management. The two main causes of a triquetral fracture are falls and car accidents. Fractures of the body of the triquetrum require more significant attention. Often pisiform fractures are with associated injuries distal radius, hamate, or triquetrum. Many carpal injuries are benign needing little or no immobilisation. It is on the ulnar side of the hand, but does not articulate with the ulna. Triquetral fractures are no true avulsion fractures because the hamate of ulnar styloid process acts as a chisel chipping away a small dorsal fragment of the os triquetrum rather. Three cases of nonunion of the triquetrum with pseudoarthrosis. Intraoperative findings confirmed the diagnosis of right triquetral fracture, with instability and subluxation of the pisiform and fracture fragment over the triquetrum fig. Triquetral definition of triquetral by the free dictionary.
Factors predictive of this complication include smoking, longer time elapsed since the fracture, and avascular necrosis avn of the proximal fragment. Treatment of nonunion of a triquetral body fracture. There is a small avulsion from the dorsum of the triquetrum seen only on the lateral projection red arrow. The triquetrum is the second most commonly fractured carpal bone. Carpal bone fractures make up a significant proportion of injuries to the wrist. This injury may be accompanied by fractures of the ulnar styloid, the distal ulna, and the scaphoid. They are the second commonest carpal bone fracture, after the scaphoid. Digital fractures are much more common than hand fractures, and may present as open fractures with. This is discussed in the separate article wrist fractures. Request pdf on jan 1, 2008, yohei kawakami and others published treatment of nonunion of a triquetral body fracture find, read and cite all the research you need on researchgate. Treatment of nonunion of a triquetral body fracture yohei kawakami, md, hiroyuki fujioka, md, and masahiro kurosaka, md journal of hand surgery european volume 2016 32. In the printed or pdf version of this article, author affiliations can be found at the.
Apply the principles of fracture management to maximize outcomes. The scaphoid fractures present some of the greatest dilemmas in management of hand fractures. Sep 04, 2018 a triquetral bone is fractured less frequently when compared to the fractures of the scaphoid and lunate bones of the same area. Computed tomography and magnetic resonance imaging demonstrated a triquetral fracture with a subluxated pisiform. Can be due to many things, post fracture joint issues, things that have nothing to do with the actual fracture such as arthritis or tendonitis and some things that overlap, a careful followup exam. Pathomechanical aspects of the origin of the fracture were also considered. Sep 19, 2014 the wrist is the most commonly injured joint in the body. The complex bone shape and articulations make diagnosis more difficult and missed injuries more common. To the best of our knowledge, this is the first case in which a simultaneous bilateral triquetral fracture is reported. After 4 weeks of right wrist immobilization 2 and 2 weeks of physical therapist intervention, the patient was asymptomatic and returned to full functional activities. Magnetic resonance imaging or bone scintigraphy may be. Most fractures are due to local trauma caused by an applied force.
There is a wide spectrum of carpal injuries, from minor to complex. Apr 06, 2015 the triquetrum refers to a part of the wrist known as the triquetral bone. Although triquetral fracture with subluxation of the pisotriquetral joint is. Meaning peashaped, this carpal bone is rare to fracture. Triquetral definition of triquetral by medical dictionary. There are three main causes of triquetral bone fractures. After a visit from the doctor, or hearing a friend say that they have a triquetral fracture, you probably want to know what that means. The fracture was initially reduced by being held with a kwire and fixed with a 1.
Triquetral fractures happen when you injure one of the small bones in your outer wrist called the triquetrum. Fractures of the triquetrum are seldom encountered. Thomas and birch reported that compression in ulnardeviation with palmar flexion causes a coronal hamate body fracture, when the hamate abuts against the triquetral and a force directed through the metacarpals splits the hamate coronally. It appears that the chisel action of the dorsoproximal edge of the hamate striking against the fully extended and ulnardeviated wrist is the major cause of the dorsal chip fracture of the triquetrum. A triquetral bone is occasionally called as a triquetrum. Learning radiology triquetral fracture, fracture of the. Discuss important neurovascular considerations blood supply etc. Lateral radiographsandor45 pronated obliqueviewspro.
Avulsions of the hand and wrist are a heterogeneous group of injuries, but they often have a characteristic imaging appearance that relates to the intricate bone and softtissue anatomy and the mechanism of injury. The treatment of fractures of the carpal bones is challenging and may differ according to localization. Isolated displaced nonunion of a triquetral body fracture. Triquetral fracture with associated pisiform subluxation. Triquetral fractures are classified as fractures of the body or flakechip fractures levy et al 1979. Fractures of this bone are usually only visible on a lateral view, and appear as a small flake of bone posterior to the carpal bones arrow. A triquetral fracture is a break of the triquetral bone. In manual workers who require high grip strengths, excision of the pisiform may. Although nonunion of triquetral body fractures is very rare, such cases are associated with considerable morbidity and reduction in functional activity. It was originally termed the cuneiform bone, when named by lyser in 1653. Neurovascular compromise from fracture requires emergent reduction andor orthopedic intervention consider risk for compartment syndrome if any limitation to range of motion, orthopedics will often perform elbow arthrocentesis to remove hemarthrosis which is often present.
From the latin triquetrus meaning having three corners. The triquetrum is the second most commonly fractured carpal bone after the scaphoid. A triquetral fracture is a break of the triquetral bone sometimes called triquetrum. The article focuses on helping students to identify triquetral bone fractures and it also suggests adapted alternative techniques to demonstrate the triquetral bone. In this case, the patients dorsal triquetrum fracture was detected on the initial. The next most common carpal bone to fracture after the scaphoid is the triquetral.
Simultaneous bilateral triquetral fractures, acquired in two. Avulsion fractures of the volar aspect of triquetral bone of the wrist. It is also known as the triquetral bone, and in the past the pyramidal or triangular bone triquetrum fractures in isolation are uncommon. It was first called the triquetrum by albinus in 1726. The study focuses on elements of triquetral fracture management within these six centres. Specifically, the bone is part of the carpus, a group of eight wrist bones. Carpal fractures in athletes excluding the scaphoid hand therapy. Fractures generally occur when the wrist is overextended.
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