Initial Treatment of Triquetral Fracture
Most triquetral fractures should be treated with conservative management consisting of wrist immobilization for 3 weeks, which results in good outcomes and complete healing in the vast majority of cases. 1
Immediate Pain Management
Administer regular paracetamol (acetaminophen) immediately as first-line analgesia unless contraindicated, as effective pain control is the foundation of acute fracture care. 2
Add opioid analgesia cautiously if needed, particularly in elderly patients or those with unknown renal function, as approximately 40% of fracture patients have moderate renal dysfunction. 2
Avoid NSAIDs until renal function is confirmed, as they are relatively contraindicated in fracture populations with high rates of renal impairment. 2
Document pain scores at rest and with movement before and after analgesia administration. 3
Immobilization Protocol
Immobilize the injured wrist with a well-padded volar splint for 3 weeks, which has proven successful in achieving fracture healing. 1
The splint should extend from the metacarpal heads to just below the elbow to adequately immobilize the wrist and forearm. 2
If bone fragment healing occurs, it typically takes 6 to 8 weeks for complete union. 1
Fracture Type Considerations
The treatment approach depends on the specific fracture pattern:
Dorsal cortical fractures (most common type, comprising the majority of triquetral fractures) are usually benign and respond well to conservative immobilization. 4
Triquetral body fractures require more careful evaluation but still typically heal with conservative management unless significantly displaced. 4, 1
Volar cortical fractures (least common) can be more problematic and require closer monitoring. 4
Indications for Surgical Intervention
Surgery is reserved for specific circumstances and is not indicated for the vast majority of triquetral fractures:
Fractures with significant displacement of fragments 4
Evidence of carpal instability 4
Symptomatic nonunion after failed conservative treatment (rare complication) 5, 6
Early Mobilization
Begin early mobilization as the patient's pain allows once the initial immobilization period is complete. 7, 3
Aggressive finger and hand motion exercises are necessary when immobilization is discontinued to facilitate the best possible outcomes. 7
Critical Pitfalls to Avoid
Do not delay pain management while focusing on radiographic evaluation—pain control should be the immediate priority. 2
Do not prescribe NSAIDs without checking renal function first. 2
Maintain clinical suspicion for triquetral body fractures in patients with ulnar-sided wrist pain after falling on an outstretched hand, as these can be missed on plain radiographs and may require CT or MRI for definitive diagnosis. 5
There is no indication for surgical intervention in uncomplicated dorsal chip fractures, and conservative therapy has proven successful without signs of post-traumatic instability or avascular necrosis. 1