From the Guidelines
Immobilization with a short arm cast or splint is the recommended treatment for a triquetral fracture, especially when fracture fragments are small, nonarticular, or minimally displaced. The treatment approach for a triquetral fracture should prioritize immobilization to allow proper healing, along with effective pain management. According to 1, simple immobilization is appropriate for small, nonarticular, or minimally displaced fracture fragments.
Immobilization
- Immobilization can be achieved with a short arm cast or splint, with the wrist in a neutral position, for a period of 4-6 weeks.
- This method supports the natural healing process of the bone and reduces the risk of further injury.
Pain Management
- Pain management is crucial and can include the use of NSAIDs such as ibuprofen (400-600mg every 6-8 hours) or naproxen (500mg twice daily).
- Acetaminophen (650-1000mg every 6 hours) can be used for breakthrough pain, providing additional relief when needed.
- Applying ice for 15-20 minutes several times daily during the first 48-72 hours can help reduce swelling and discomfort.
Rehabilitation
- After the immobilization period, gentle range-of-motion exercises should be initiated to prevent stiffness.
- Gradual strengthening exercises can then be introduced to restore wrist function and strength.
- Physical therapy may be beneficial for some patients, especially those with significant loss of function or persistent pain.
Surgical Intervention
- Surgery is rarely necessary unless there is significant displacement, instability, or associated ligament injuries.
- The decision for surgical intervention should be made on a case-by-case basis, considering the individual patient's condition and the potential benefits and risks of surgery, as noted in 1.
From the Research
Treatment for Triquetral Fracture
The recommended treatment for a triquetral fracture includes immobilization and pain management.
- Immobilization is usually achieved through the use of a splint, which helps to stabilize the wrist and allow the fracture to heal properly 2.
- Nonsurgical management is indicated for most triquetral fractures, which usually results in good outcomes 2.
- Surgical treatment is indicated for fractures with significant displacement or evidence of instability 2.
Types of Triquetral Fractures
There are three main types of triquetral fractures:
- Dorsal cortical fractures, which are the most common and are usually benign 2.
- Triquetral body fractures 2.
- Volar cortical fractures, which are the least common and can be problematic 2.
Complications of Triquetral Fractures
Complications of triquetral fractures include:
- Non-union 2.
- Triangular fibrocartilage complex injury 2, 3.
- Pisotriquetral arthritis 2.
- Carpal instability, which can result from volar triquetral avulsion fractures 3.
Evaluation and Diagnosis
Evaluation and diagnosis of triquetral fractures should be thorough, as they can be easily missed with conventional wrist radiographs 3.