From the Guidelines
Treatment for a triquetral fracture typically involves simple immobilization when fracture fragments are small, nonarticular, or minimally displaced. This approach is based on the principle of minimizing intervention while allowing the fracture to heal naturally, thereby reducing the risk of complications and promoting optimal recovery 1. The goal of treatment is to alleviate pain, prevent further injury, and restore function to the wrist.
Key Considerations
- Immobilization is the primary treatment method for non-displaced or minimally displaced triquetral fractures 1.
- The decision to immobilize is based on the size and displacement of the fracture fragments, as well as the presence of articular involvement.
- Surgery may be considered in cases where the fracture is displaced or involves the articular surface, but this is not typically the first line of treatment 1.
Management Strategies
- Immobilization can be achieved with a short arm cast or splint, which should be worn for a period of 4-6 weeks to allow for adequate healing.
- Pain management is crucial during the initial stages of treatment and can be achieved with acetaminophen or NSAIDs, such as ibuprofen.
- Ice application and rest are also important components of the treatment plan, as they help reduce swelling and pain.
- Gentle range-of-motion exercises and gradual strengthening can be introduced after immobilization to restore function and promote recovery.
From the Research
Treatment Options for Triquetral Fractures
- Nonsurgical management is indicated for most triquetral fractures, which usually results in good outcomes 2
- Immobilization is a common treatment for triquetral fractures, though they should be thoroughly evaluated due to their potential to result in instability, loss of motion, and arthrosis 2
- Dorsal cortical fractures respond well to a short time splint or cast support 3
- Non-displaced fractures of the body can be treated by immobilization for four to six weeks 3
- Displacement of body fractures is very rare and often the result of perilunate instability, which usually requires open reduction, internal fixation and ligament repair 3
Surgical Treatment
- Surgical treatment is indicated for fractures with significant displacement or evidence of instability 2
- Open reduction, internal fixation and ligament repair may be necessary for displaced body fractures 3
- Operative treatment with ligament reconstruction and joint stabilization with K-wires followed by longer immobilization may be required for acute complete ligament disruption with static instability 3
Pain Management
- Acetaminophen may be adequate for pain relief after operative treatment of an extremity fracture, and is noninferior to combination therapy with acetaminophen and tramadol 4