Triquetral fractures—a retrospective, multi-centre study of management and outcomes

Main Article Content

Alyse Hopkins
Sebastian RA Bowman
Angelo P Preketes
Michael B Dowd

Keywords

Wrist, triquetrum bone, bone fractures, radiography, computed x-ray topography

Abstract

Introduction: This study examines triquetral fracture data from six hospital centres between 2009 and 2018. The study focuses on elements of triquetral fracture management within these six centres, outlining common fracture patterns, the short-term and long-term outcomes and the common mechanisms of injury. To the authors’ knowledge, this is the largest cohort of triquetral fractures studied to date and outlines investigation recommendations for improved identification of these fractures.


Methods: Data was obtained by reviewing the charts of patients presenting to emergency departments within the Nepean and Blue Mountains local health district of New South Wales, Australia. (Nepean Hospital ethics approval no: NBM18/805)


Results: Triquetral fractures can be hard to identify with radiography and can be commonly mistaken as lunate fractures.12 Our results indicate that 18.9 per cent of patients required CT imaging to correctly diagnose triquetral fracture.


Conclusion: Where there are ongoing symptoms and a high clinical suspicion of a triquetral fracture, CT may be indicated and, in future practice, may be justified as a first line imaging modality. This study also demonstrates that short arm-wrist immobilsing casts are an effective option for managing triquetral fractures.

Metrics

Metrics Loading ...
Abstract 425 | PDF Downloads 860 HTML Downloads 86

References

1. Garcia-Elias M. Dorsal fractures of the triquetrum—avulsion or compression fractures? J Hand Surg-Am. 1987;12(2):266–68. https://doi.org/10.1016/S0363-5023(87)80285-X
2. Levy M, Fischel R, Stern G, Goldberg I. Chip fractures of the os triquetrum: the mechanism of injury. J Bone Joint Surg Br. 1979;61(3):355–57. https://doi.org/10.1302/0301-620X.61B3.479259 PMid:479259
3. Suh N, Ek ET, Wolfe SW. Carpal fractures. J Hand Surg-Am. 2014;39(4):785–91. https://doi.org/10.1016/j.jhsa.2013.10.030 PMid:24679911
4. Putnam M, Meyer N. Carpal fractures excluding the scaphoid. Hand Surgery Update. 2003;3:175–87. https://doi.org/10.1007/978-1-4471-6554-5_11
5. Nixon M, Trail IA. Fractures of carpal bones other than the scaphoid. In: Trail IA, Fleming ANM (ed). Disorders of the hand. London Springer, 2015; p. 237–48. https://doi.org/10.1007/978-1-4471-6554-5_11
6. De Beer JDV, Hudson D. Fractures of the triquetrum. J Hand Surg-Brit Eur. 1987;12(1):52–3. https://doi.org/10.1016/0266-7681(87)90056-8
7. Becce F, Theumann N, Bollmann C, Omoumi P, Richarme D, Guerini H, Campagna R, Meuli R, Drape J. Dorsal fractures of the triquetrum: MRI findings with an emphasis on dorsal carpal ligament injuries. Am J Roentgenol. 2013;200(3):608–17. https://doi.org/10.2214/AJR.12.8736 PMid:23436851
8. Höcker K, Menschik A. Chip fractures of the triquetrum: mechanism, classification and results. J Hand Surg Eur-Vol. 1994;19(5):584–88. https://doi.org/10.1016/0266-7681(94)90120-1
9. Durbin F. Non-union of the triquetrum. J Bone Joint Surg Br. 1950;32(3):388. https://doi.org/10.1302/0301-620X.32B3.388
10. Sin C-H, Leung Y-F, Ip SP-S, Wai Y-L, Ip W-Y. Non-union of the triquetrum with pseudoarthrosis: a case report. J Orthop Surg-Hong K. 2012;20(1):105–7. https://doi.org/10.1177/230949901202000122 PMid:22535823
11. Bartone NF, Grieco RV. Fractures of the triquetrum. J Bone Joint Surg. 1956;38(2):353–6. https://doi.org/10.2106/00004623-195638020-00012
12. Bonnin JG, Greening W. Fractures of the triquetrum. Brit J Surg. 1944;31(123):278–83. https://doi.org/10.1002/bjs.18003112314
13. Vigler M, Aviles A, Lee SK. Other carpal fractures: lunate, triquetrum, capitate, hamate, hamate hook, trapezoid/trapezium. In: Slutzky D, (ed) Principles and practice of wrist surgery. Elsevier, 2010. p. 289–300 https://doi.org/10.1016/B978-1-4160-5646-1.00025-4