What is the treatment for a triquetral fracture?

Treatment of Triquetral Fractures

The treatment of choice for most triquetral fractures is conservative management with immobilization using a short arm cast or volar splint for 3-6 weeks, with the wrist in a neutral position. 1, 2, 3

Types of Triquetral Fractures

Triquetral fractures can be classified into three main types:

• Dorsal chip fractures: Most common type (70-80%)
• Body fractures: Less common but more serious
• Volar cortical fractures: Least common and potentially problematic

Treatment Algorithm

Non-displaced Fractures (Most Common)

1. Initial Management:

   • Immobilization with a short arm cast or volar splint for 3-6 weeks 2, 3
   • Wrist should be maintained in a neutral position 1
   • Active finger motion exercises should begin immediately to prevent stiffness 1
   • Ice application during first 3-5 days for symptomatic relief 1

2. Follow-up:

   • Radiographic follow-up at 3 weeks and at cessation of immobilization 1
   • Complete healing typically occurs within 6-8 weeks 2

3. Rehabilitation:

   • After immobilization period, begin progressive range of motion exercises 1
   • Gradual return to activities as tolerated 1

Displaced Fractures

Surgical fixation is recommended for fractures with significant displacement or evidence of instability. 3, 4

Indications for surgical intervention include:

• Significant displacement of fragments
• Evidence of carpal instability
• Failed conservative management with persistent symptoms 1

Potential Complications

• Non-union: Rare but can occur, especially with body fractures 4
• Triangular fibrocartilage complex (TFCC) injury: May cause persistent ulnar-sided wrist pain even after fracture healing 5
• Pisotriquetral arthritis: Can develop as a late complication 3
• Stiffness: Can result from excessive immobilization 1

Important Clinical Considerations

• Triquetrum is the second most commonly fractured carpal bone (15-18% of all carpal fractures) 3
• These fractures are often missed on initial radiographs, especially body fractures 4
• Persistent ulnar-sided wrist pain after treatment may indicate associated TFCC injury 5
• CT scan or MRI should be considered for better diagnostic accuracy in complex cases or persistent pain 1, 4
• Conservative treatment has shown excellent outcomes in most cases, with no indication for surgical intervention in non-displaced fractures 2
• Avascular necrosis is extremely rare due to good vascularization of the bone 2

Special Considerations

For patients with persistent ulnar-sided wrist pain after appropriate immobilization and fracture healing, consider:

• TFCC injury evaluation with physical examination and possibly MRI 5
• Arthroscopic intervention may be necessary for TFCC injuries causing persistent pain 5

The prognosis for properly treated triquetral fractures is generally excellent, with most patients returning to full function without long-term sequelae 2, 3.