- Kevin deWeber, MD, FAAFP, FACSM
Kevin deWeber, MD, FAAFP, FACSM
- Family Medicine of SW Washington Residency
- PeaceHealth SW Medical Center
- Affiliate Associate Professor of Family Medicine
- Oregon Health and Science University
- Clinical Instructor of Family Medicine
- University of Washington School of Medicine
This topic will review issues related to fractures of the triquetrum. General overviews of wrist pain and carpal fractures, as well as topics devoted to other specific carpal fractures in adults, are presented separately. (See "Evaluation of the adult with acute wrist pain" and "Evaluation of the adult with subacute or chronic wrist pain" and "Overview of carpal fractures" and "Scaphoid fractures" and "Hamate fractures" and "Lunate fractures" and "Capitate fractures".)
Hand fractures are among the most common of the extremity injuries, accounting for about 18 percent of all fractures. Carpal bone fractures comprise between 8 and 19 percent of hand fractures . Fractures to bones of the proximal carpal row—comprising the scaphoid, lunate, triquetrum and pisiform bones—are most frequent. The triquetrum is the second most common carpal fracture after the scaphoid, representing 13 to 28 percent of all carpal bone injuries [1-4].
The triquetrum is located just distal to the ulna and the triangular fibrocartilage complex (TFCC), and proximal to the base of the hamate (image 1 and figure 1 and figure 2). The triquetrum is a small, pyramid-shaped bone that is largely covered in ligaments that connect it to surrounding structures. The triquetrum articulates with three bones: lunate, pisiform, and hamate. The lateral surface of the triquetrum is flat and articulates with the lunate, to which it is attached by the lunotriquetral ligament. The distal end faces laterally forming the sinuous, concave facet that articulates with the hamate bone. The ventromedial facet that articulates with the pisiform bone is oval shaped. The proximal end of the triquetrum forms a smooth facet for articulation with the TFCC and distal radioulnar joint. The anatomy of the wrist is discussed in greater detail separately. (See "Anatomy and basic biomechanics of the wrist".)
The triquetrum is palpable on the ulnar or dorsal aspect of the wrist just distal to the ulnar styloid and TFCC, but distinguishing it from the more distal hamate may be difficult, and the extensor carpi ulnaris (ECU) tendon may be superficial to it, further complicating palpation. Placing the wrist into radial deviation may make it more prominent and palpable.
MECHANISM OF INJURY
Triquetrum fractures typically occur from a fall onto an outstretched arm with the wrist in extension and ulnar deviation, or in extreme flexion . Shearing forces exerted by the proximal hamate, distal ulna, or both may play a role. In addition, either the dorsal or volar radiotriquetral ligaments may avulse triquetral fragments at their attachments.
- van Onselen EB, Karim RB, Hage JJ, Ritt MJ. Prevalence and distribution of hand fractures. J Hand Surg Br 2003; 28:491.
- Welling RD, Jacobson JA, Jamadar DA, et al. MDCT and radiography of wrist fractures: radiographic sensitivity and fracture patterns. AJR Am J Roentgenol 2008; 190:10.
- Balci A, Basara I, Çekdemir EY, et al. Wrist fractures: sensitivity of radiography, prevalence, and patterns in MDCT. Emerg Radiol 2015; 22:251.
- Hey HW, Chong AK, Murphy D. Prevalence of carpal fracture in Singapore. J Hand Surg Am 2011; 36:278.
- Urch EY, Lee SK. Carpal fractures other than scaphoid. Clin Sports Med 2015; 34:51.
- Suh N, Ek ET, Wolfe SW. Carpal fractures. J Hand Surg Am 2014; 39:785.
- Marchessault J, Conti M, Baratz ME. Carpal fractures in athletes excluding the scaphoid. Hand Clin 2009; 25:371.
- Papp S. Carpal bone fractures. Hand Clin 2010; 26:119.
- Papp S. Carpal bone fractures. Orthop Clin North Am 2007; 38:251.
- Sawardeker PJ, Baratz ME. Carpal injuries. In: DeLee & Drez's Orthopaedic Sports Medicine: Principles and Practice, 4th ed, Miller MD, Thompson SR. (Eds), Saunders Elsevier, Philadelphia 2015. p.857.
- CLINICAL ANATOMY
- MECHANISM OF INJURY
- SYMPTOMS AND EXAMINATION FINDINGS
- RADIOGRAPHIC FINDINGS
- DIFFERENTIAL DIAGNOSIS
- Fracture of other carpal bones
- Fracture-dislocations of carpal bones
- Distal radius or ulna fractures
- Wrist sprain
- Pisotriquetral osteoarthritis
- Extensor carpi ulnaris tendinopathy and subluxation
- Triangular fibrocartilage complex (TFCC) injury
- INDICATIONS FOR SURGICAL REFERRAL
- FOLLOW-UP CARE
- RECOMMENDATIONS FOR RETURN TO SPORT OR WORK
- SUMMARY AND RECOMMENDATIONS