Most transverse fractures of the triquetrum are treated with casts. For the avulsion fractures of the volar side of the triquetrum the proposed. Triquetral fractures are the second most common carpal fractures with a prevalence of 18. Before concluding a normal study, ensure you asses the dorsal aspect of the lateral projection carefully. You may need to spend a few weeks on crutches if you have an avulsion fracture around your hip. Ct scan ct scan of the wrist is useful, in cases where the plain radiographs are inconclusive, yet. Fractures and avulsion fractures of the triquetrum are. When the triquetral body is displaced, orif may be required. They are the second commonest carpal bone fracture, after the scaphoid. Avulsion fractures can occur anywhere in the body, but they are more common in a few specific locations. Triquetral fractures are, following scaphoid fractures, the second most frequently listed injuries of the carpus and account for about 2030 % of all carpal fractures.
A small avulsion fracture from the dorsum of the triquetrum. Case presentation we report the case of a 29yearold caucasian british man who sustained an isolated displaced triquetral body fracture that resulted in nonunion, who was treated surgically. The recommended initial radiographic evaluation of the triquetrum includes pa, lateral, and. Fractures of the carpal bones are by far more prevalent than dislocations. Presents with pain, swelling on lateral border of foot. A common mechanism of triquetral injury is hyperextension, causing an impaction sheartype fracture. An avulsion fracture occurs when a small chunk of bone attached to a tendon or ligament gets pulled away from the main part of the bone. Next to fractures of the scaphoid, triquetral fractures are the second most common carpal bone to fracture they are frequently seen as dorsal chip fractures only on the lateral projection since the pisiform usually overlies the triquetrum on the frontal projection of the wrist. This low incidence could be attributed to the rich vascular.
Carpal fractures in athletes excluding the scaphoid hand therapy. Fifth metatarsal fractures avulsion fracture fracture usually extraarticular. The pisiform overlies the triquetrum in the ap and oblique views and so tends to obscure this type of fracture white arrows. Learning radiology triquetral fracture, fracture of the. A triquetrial fracture normally results from impact. In this case, the patients dorsal triquetrum fracture was detected on the initial. The triquetral may be fractured by means of impingement from the ulnar styloid, shear forces, or avulsion from strong ligamentous attachments. A fracture is a break or crack in a bone that often results from an injury.
Mri of dorsal fractures of the triquetrum to our knowledge, the mri findings in dorsal fractures of the triquetrum have not yet been described in the literature. Avulsion fractures of the carpal bones are not uncommon. How to manage triquetrum and hamate fractures in unusual. The fracture was diagnosed by tomography and magnetic resonance imaging. Avulsion fractures of the scaphoid and triquetrum in a 15. When an avulsion fracture occurs, the tendon or ligament pulls off a piece of the bone. The etymology derives from the latin triquetrus which means threecornered. Project overview powerpoint presentation 5 mins for use in the emergency department to promote the new resource at staff meetings.
It is on the ulnar side of the hand, but does not articulate with the ulna. Feb 17, 2014 avulsion fracture of the dorsal ridge of the triquetrum 3. On the image, a triquetral fracture will look like a small chip of bone has separated from the back of your triquetrum. In the printed or pdf version of this article, author affiliations can be found at the bottom of the first page. Displaced triquetral chip fractures that fail to unite after conservative immobilization are rarely symptomatic enough to warrant surgical excision. An avulsion fracture is an injury to the bone in a location where a tendon or ligament attaches to the bone. Pdf nonunion of the triquetrum with pseudoarthrosis. History the general goals of fracture management are anatomic reduction of the fracture and protection of the soft tissue envelope. Simultaneous bilateral triquetral fractures, acquired in. Avulsion injuries of the hand and wrist radiographics. The study focuses on elements of triquetral fracture management within these six centres, outlining common fracture patterns, the shortterm and longterm outcomes and the common mechanisms of injury. Avulsion fractures of the dorsal ridge of the triquetrum are by far the most common fracture pattern, and these injuries typically occur from a fall on an. Nondisplaced triquetral fractures usually heal well, without complication. Place these posters in your clinical areas as a visual reminder of the resources available.
A triquetral bone is occasionally called as a triquetrum. Open fractures require immediate iv antibiotics and urgent surgical washout. The hip, elbow and ankle are the most common locations for avulsion fractures in the young athlete. Anteroposterior and lateral radiographs showed a triquetral avulsion fracture with minimal dislocation figure 1. Dislocations of the triquetrum are extremely rare because of the very strong ligamentous support between its surfaces and the. Stable fractures, where the alignment of the ankle joint is preserved, rarely need surgery. Intraarticular fracture of the distal part of the triquetrum within the. There is a small avulsion from the dorsum of the triquetrum seen only on the lateral projection red arrow. Pain control reductionstabilization splinting of the wrist with volar splint for 46 weeks orthopedic surgery follow up for reevaluation and possible orif for displaced triquetral body fractures associated with significant ligamentous injury 4. Triquetral fractures can occur due to forceful flexion of the wrist, causing an avulsion of the dorsal aspect of the bone that is often hidden on anterior radiographs, but can be seen as a tiny bone fragment on lateral views. Lateral radiographsandor45 pronated obliqueviewspro. Triquetral fractures are the second most common carpal fracture. Triquetrum fractures typically occur from a fall onto an outstretched arm with the wrist in extension and ulnar deviation, or in extreme flexion 5.
This occurs as tendons can bear more load than the bone. Key words carpal fracture, hamate, lunate, trapezium, triquetrum. The triquetral bone is the second most common carpal bone fracture, often you can only see it on the lateral as a subtle dorsal fragment. In some people, the fracture may cause little to no pain, in others, it may cause an immense amount of pain.
Refers to an avulsion injury of fdp from insertion at base of distal phalanx. Feb 10, 2012 although nonunion of triquetral body fractures is very rare, such cases are associated with considerable morbidity and reduction in functional activity. A subtle abnormality is evident at the radial aspect of the lunate. Simultaneous bilateral triquetral fractures, acquired in two. A triquetral fracture is a break of the triquetral bone sometimes called triquetrum. The triquetrum is the second most commonly fractured carpal bone after the scaphoid. It connects with the pisiform, hamate, and lunate bones. There are some common symptoms that can help you detect a triquetral fracture. Avulsion fractures of the volar aspect of triquetral bone of the wrist. How are triquetral fractures of the wrist diagnosed and. Specifically, the bone is part of the carpus, a group of eight wrist bones.
Patients with type 2 fractures fre quently undergo arthroscopy or skeletal fixation as treatment for the multiple can pal injuries on associated. Carpal fractures scott wolfe md upper extremity surgeon. Triquetral fractures are the second most common isolated carpal fracture after scaphoid fractures about 15% figs. If the fragments of the fractures are displaced, it can only be treated by open reduction and internal fixation 4. Given the variety of attached ligaments to the triquetrum, significant associated soft. Triquetral fracture with associated pisiform subluxation smj. Although they are usually managed conservatively, they are important to be aware of as they can be easily missed. Triquetral fractures can involve the dorsal rim, body, or avulsion of the volar aspect. A case of osteochondral fracture of the triquetrum associated with pisiform subluxation in a 21yearold woman is described. A triquetral bone is fractured less frequently when compared to the fractures of the scaphoid and lunate bones of the same area. Apr 06, 2015 the triquetrum refers to a part of the wrist known as the triquetral bone. Physical examination showed pain and swelling over the dorsum of the hand.
With an avulsion fracture, an injury to the bone occurs near where the bone attaches to a tendon or ligament. Offer surgical and nonsurgical treatment options for each carpal fracture. Once symptoms resolve or become less significant, rangeofmotion rom exercises can be initiated. 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. In manual workers who require high grip strengths, excision of the pisiform. 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.
An avulsion fracture is where a fragment of bone is pulled away at the ligamentous or tendinous attachment. Volar dislocation of the triquetrum case report and. Typically the only plain film evidence of injury is on the lateral view as in this case. Thus, the purpose of our study was to report the mri features of those fractures, with an emphasis on the associated dorsal carpal ligament tears. The scaphoid fractures present some of the greatest dilemmas in management of hand fractures. Many carpal injuries are benign needing little or no immobilisation.
In addition, either the dorsal or volar radiotriquetral ligaments may avulse triquetral fragments at their. However, triquetral fractures are sometimes hard to see, even on an xray. For claims with a date of service on or after october 1, 2015, use an equivalent icd10cm code or codes. Triquetral fracture with associated pisiform subluxation. Triquetral body fractures are usually nondisplaced and heal well with cast immobilization for 6 weeks.
Jan 15, 2018 the symptoms of a triquetral fracture can vary from person to person. It is one of the eight small carpal bones in the wrist and the second most commonly fractured carpal. The second fracture in our case was an inferior triquetrum fracture secondary to avulsion of the ltl. However, this converts the fracture to an open fracture, potentially changing management finger fractures in general, closed and minimally displaced fractures with good alignment can be treated conservatively. A 49yearold man presented to the emergency department at 10. Chip, flake, traction, or avulsion fractures of the dorsal aspect of the triquetrum often do not unite and may form a permanent ossicle. Sep 26, 2019 if the fracture is minimally displaced, it should be treated with cast immobilization for 46 weeks, with rom exercises beginning after cast removal. Triquetral fractures are the most common carpal fracture after scaphoid fractures. Persistent ulnarsided wrist pain after treatment of triquetral dorsal chip fracture. Apr, 2017 a fracture is a break or crack in a bone that often results from an injury. Triquetral fractures are the second most common carpal bone fractures after scaphoid fractures. The injury was treated with a dorsal forearm splint.
Fractures of the pelvis, which often cannot be controlled quickly by any other method. The importance of proper roentgenograms in ulnar sided wrist pain. Isolated displaced nonunion of a triquetral body fracture. External fixation permits adjustment of length and angulation some allow reduction of the fracture in all 3 planes.
The majority of fractures are dorsal ridge fractures, which occur at the dorsal aspect of the triquetrum, fig 8. Closed fracture of triquetral cuneiform bone of wrist. Pathomechanical aspects of the origin of the fracture were also considered. Greater than 90% of triquetrum fractures are avulsions along the dorsal ridge, with the remaining fractures occurring within the body and on the volar surface of the triquetrum. The majority of avulsion fractures of the triquetrum are classified as chip fractures involving the dorsal cortex. Triquetral fractures are carpal bone fractures generally occuring on the dorsal surface of the triquetrum. Let us go over what a triquetral fracture is for more. 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. 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. Three cases of nonunion of the triquetrum with pseudoarthrosis.
Fractures of the triquetrum usually occur from forced hyperflexion or as an avulsion injury. Triquetral fracture with associated pisiform subluxation ncbi. The two main causes of a triquetral fracture are falls and car accidents. Especially applicable to the long bones and the pelvis. The mechanism of injury is often a fall with the hand in hyperextension and ulnar deviation. Isolated fractures of the triquetrum are the third most common carpal fracture and the most common type is a chisel fracture. Neurovascular compromise from fracture requires emergent reduction andor orthopedic intervention. Management of fifth metatarsal fractues terrence m. 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. Triquetral chip fractures are treated symptomatically with 23 weeks of immobilization if discomfort becomes significant. They result from impingement of the ulnar styloid process against the dorsal surface of the triquetrum.
Shearing forces exerted by the proximal hamate, distal ulna, or both may play a role. The pisiform overlies the triquetrum in the ap and oblique views and tends to obscure the fracture white arrows. Fifth metatarsal fractures tuberosity fracture treatment walking boot x4 weeks, wb as tolerated healing can be. 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. Although nonunion of triquetral body fractures is rare, such cases can lead to considerable disability. Triquetrum fractures are the second most common carpal fractures after. Childhood fracture management education powerpoint presentation 30. It can be caused by a traumatic traction repetitive longterm or a single high impact traumatic traction of the ligament or tendon. Avulsion fracture causes and treatments verywell health. Jan 09, 2020 avulsion injuries of the hand and wrist and the conditions that mimic them are commonly encountered in radiology practice, and understanding the intricate bone and softtissue anatomy can help the radiologist recognize and characterize the imaging appearance and treatment of avulsion injuries. Avulsion fracture of the dorsal ridge of the triquetrum 3. Examination revealed tenderness over the scapholunate ligament and a positive watsons maneuver during examination under anesthetic. Avulsion injuries of the hand and wrist and the conditions that mimic them are commonly encountered in radiology practice, and understanding the intricate bone and softtissue anatomy can help the radiologist recognize and characterize the imaging appearance and treatment of avulsion injuries.
It differs from an avulsion fracture of the triquetral corner, which is regarded as ligamentous injury only. We all know that there are different kinds of breaks you can get when injured. The triquetrum is the most frequently fractured of these bonesthe second most overallwith the reported incidence of triquetrum fractures ranging from 3. It is seen only on the lateral projection red arrow. A sudden, direct impact is the most common cause, resulting in wrist pain on the little finger side. Racgp hands, fingers, thumbs assessment and management. During radial wrist deviation, it also articulates with the capitate. There is a wide spectrum of carpal injuries, from minor to complex. It can occur at numerous sites in the body, but some areas are more.
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