Treatment of Triquetral Fractures
Most triquetral fractures should be treated conservatively with immobilization for 3 weeks, as this approach has proven successful with good outcomes and no indication for surgical intervention in the vast majority of cases. 1, 2
Fracture Classification and Treatment Algorithm
Triquetral fractures comprise 15-18% of all carpal bone fractures and fall into three main categories that guide treatment 3:
Dorsal Cortical Fractures (Most Common)
- Treat with short-term splint or cast immobilization for 3 weeks 1, 4, 2
- These fractures are typically benign and respond well to conservative management 3
- The mechanism involves a chisel-like action of the dorsoproximal edge of the hamate striking the triquetrum during falls on an extended and ulnar-deviated wrist 1, 2
- Bony fragment healing occurs within 6-8 weeks if union is achieved 1, 2
- No surgical intervention is indicated for isolated dorsal chip fractures 1, 2
Triquetral Body Fractures (Less Common)
Non-displaced body fractures:
- Immobilize for 4-6 weeks 4
- All body fractures in follow-up studies resulted in osseous consolidation with conservative treatment 1, 2
Displaced body fractures:
- These are very rare and often associated with perilunate instability 4
- Require open reduction, internal fixation, and ligament repair 4
- Displacement indicates significant carpal instability requiring surgical intervention 4
Volar Cortical Fractures (Least Common)
- These are the least common type and can be problematic 3
- Treatment approach follows similar principles to body fractures based on displacement 3
Key Clinical Considerations
Evaluation priorities:
- Thoroughly assess for associated injuries including triangular fibrocartilage complex (TFCC) injury, lunotriquetral ligament disruption, and signs of perilunate instability 3, 4
- Avascular necrosis is not a concern due to good vascularization of the triquetrum 1, 2
- Post-traumatic instability is rare with isolated triquetral fractures 1, 2
Common pitfalls to avoid:
- Missing associated lunotriquetral ligament injuries—if complete ligament disruption with static instability is present, operative treatment with ligament reconstruction and K-wire stabilization is required 4
- Failing to recognize displacement or perilunate instability patterns that mandate surgical intervention 4
- Triquetral fractures should remain in the differential diagnosis for ulnar-sided wrist pain after falls on an outstretched hand 3
Outcomes and Complications
- Conservative management typically results in good outcomes for most triquetral fractures 3, 1
- Potential complications include nonunion (rare), TFCC injury, and pisotriquetral arthritis 3
- Symptomatic nonunions are extremely rare but may require surgical excision of the ununited fragment if conservative treatment fails 5