Management of Subcentimetre Avulsion Fracture of the Triquetrum
Conservative management with immobilization for 3 weeks is the definitive treatment for subcentimetre triquetral avulsion fractures, with no indication for surgical intervention. 1, 2
Immediate Management
Provide appropriate analgesics immediately to ensure adequate pain control before initiating any diagnostic workup or rehabilitation activities. 3 Options include acetaminophen, NSAIDs, or opioids if pain is severe. 4
Immobilize the wrist in a short-arm cast or splint for 3 weeks. 1, 2 This conservative approach has proven highly successful for dorsal chip fractures of the triquetrum, which represent the most common type of triquetral fracture and are typically benign. 5
Key Clinical Points
Dorsal cortical (chip) avulsion fractures are the most common triquetral fracture type (comprising 15-18% of all carpal fractures), typically caused by the chisel-like action of the dorsoproximal edge of the hamate striking against the fully extended and ulnar-deviated wrist. 1, 5, 2
Osseous healing of the bone fragment takes 6 to 8 weeks, though clinical immobilization for 3 weeks is sufficient. 1, 2
Surgery is never indicated for these fractures. 1, 2 All studies demonstrate excellent outcomes with conservative treatment alone, with no evidence of post-traumatic instability or avascular necrosis due to good vascularization of the triquetrum. 1, 2
Rehabilitation Protocol
Begin early range-of-motion exercises after the 3-week immobilization period. 3 Progressive return to wrist motion should be followed by strengthening exercises over the subsequent 5 weeks. 6
Early mobilization as pain allows is critical to prevent stiffness and optimize functional recovery. 3, 7
Follow-Up Expectations
Complete resolution of pain and excellent wrist function can be expected within 3-12 months after injury with appropriate conservative management. 6
Monitor for persistent pain, loss of motion, or signs of instability during follow-up, though these complications are rare with proper initial treatment. 5
Common Pitfalls to Avoid
Do not over-immobilize beyond 3 weeks, as prolonged immobilization leads to unnecessary stiffness without improving fracture healing. 1, 2
Do not pursue surgical treatment for simple dorsal chip fractures, as there is no evidence of benefit and it exposes patients to unnecessary surgical risks. 1, 2
Do not confuse dorsal chip fractures with triquetral body fractures or volar cortical fractures, which may require different management strategies. 5 Body fractures and volar fractures are much less common and can be more problematic, potentially requiring surgical intervention if significantly displaced or unstable. 5, 8
Ensure proper imaging evaluation including standard and oblique wrist radiographs to confirm the diagnosis and exclude associated ligamentous injuries or carpal instability. 6