Treatment of Slightly Displaced Triquetral Fractures
Conservative management with immobilization for 3 weeks is the recommended treatment for slightly displaced triquetral fractures, as this approach consistently achieves successful outcomes without need for surgical intervention. 1, 2
Initial Management
- Immobilize the wrist with a volar splint or removable splint for 3 weeks 1, 3, 2
- Begin active finger motion exercises immediately following diagnosis to prevent finger stiffness, which is one of the most functionally disabling complications 4, 5
- Finger motion exercises do not adversely affect adequately stabilized fractures 5, 6
Radiographic Follow-Up Protocol
- Obtain radiographs at approximately 3 weeks post-immobilization to assess healing progress 4, 5
- Obtain final radiographs at time of immobilization removal to confirm adequate healing 4, 5
- Complete bony healing of triquetral fragments typically occurs at 6 to 8 weeks, though clinical immobilization is only 3 weeks 1, 2
When Surgery Is NOT Indicated
- Surgical intervention is not indicated for slightly displaced triquetral fractures 1, 2
- All triquetral body fractures treated conservatively in follow-up studies achieved complete osseous consolidation 1, 2
- No cases of post-traumatic wrist instability were observed with conservative treatment 1, 2
- Avascular necrosis is not a concern due to good vascularization of the triquetrum 1, 2
When to Consider Surgery
Surgery is only indicated if there is:
- Significant displacement of fragments (though specific thresholds are not well-defined for triquetral fractures) 7
- Evidence of carpal instability 7
- Associated pisotriquetral joint subluxation, which requires open reduction and lag screw fixation 8
Common Pitfalls to Avoid
- Do not over-immobilize beyond 3 weeks, as excessive immobilization leads to stiffness that is difficult to treat and may require multiple therapy visits or additional surgical intervention 6
- Do not restrict finger motion during the immobilization period - patients must move uninvolved fingers regularly through complete range of motion 6
- Evaluate thoroughly for associated injuries, particularly triangular fibrocartilage complex injury and pisotriquetral joint involvement, as these can result in instability, loss of motion, and arthrosis 7, 8
Expected Outcomes
- Conservative treatment with 3-week immobilization has proven consistently successful 1, 3, 2
- Complete functional remission is expected 3
- Complications such as non-union are extremely rare (only one case reported in the literature) 3
- All body fractures of the triquetrum achieve osseous consolidation with conservative management 1, 2