From the Guidelines
Surgery is the usual treatment for triquetral fractures, but simple immobilization is appropriate when fracture fragments are small, nonarticular, or minimally displaced. Management of triquetral fractures typically involves immobilization with a short arm cast or splint for 4-6 weeks, depending on fracture type and severity 1. For dorsal chip fractures, which are the most common type, a removable wrist splint may be sufficient, while complete fractures often require a short arm cast with the wrist in slight extension.
Key Considerations
- The diagnosis of triquetral fractures is based on a history of trauma and focal pain on palpation and is confirmed with radiographic studies 1.
- Pain management includes NSAIDs such as ibuprofen 400-600mg every 6-8 hours or naproxen 500mg twice daily, along with acetaminophen 650mg every 6 hours as needed.
- Most triquetral fractures heal well with conservative treatment, but patients should be monitored with follow-up radiographs at 2-3 weeks to ensure proper healing.
- Physical therapy is recommended after immobilization to restore range of motion and strength, typically 2-3 sessions per week for 3-4 weeks.
- Surgery is rarely needed but may be considered for displaced fractures, persistent pain, or when associated with other carpal injuries 1.
Outcomes
- The triquetrum's good blood supply generally leads to favorable healing outcomes, but patients should be advised that complete recovery may take 3-6 months, with gradual return to activities as pain and function improve.
From the Research
Types of Triquetral Fractures
- Dorsal cortical fractures: the most common type, usually benign 2
- Triquetral body fractures: can be problematic, especially if displaced 2, 3
- Volar cortical fractures: the least common type, can be problematic 2
Management of Triquetral Fractures
- Nonsurgical management: indicated for most triquetral fractures, usually results in good outcomes 2, 3
- Immobilization: a common treatment approach, can be used for 3-6 weeks 4, 3
- Surgical treatment: indicated for fractures with significant displacement or evidence of instability 2, 3
- Excision of the ununited fragment: a possible treatment option for rare cases of triquetral body fracture nonunion 5
Complications of Triquetral Fractures
- Non-union: a possible complication, especially in cases of triquetral body fractures 5
- Triangular fibrocartilage complex injury: a possible complication 2
- Pisotriquetral arthritis: a possible complication 2
- Instability and loss of motion: possible complications if left untreated or undertreated 2, 3