Management of Asymptomatic Triquetral Dorsal Chip Fracture at 3 Weeks
Discontinue the volar splint and allow the patient to return to normal activities with active range of motion exercises, as conservative treatment for 3 weeks has proven successful for dorsal chip fractures of the triquetrum, and the patient's excellent clinical status (pain-free with good ROM) indicates adequate healing regardless of persistent radiographic findings. 1
Clinical Decision-Making Algorithm
Key Clinical Indicators Support Discontinuation of Immobilization:
- Pain-free status is the most important clinical indicator of successful healing 1
- Good range of motion at 3 weeks indicates no functional impairment 1
- Dorsal chip fractures specifically respond well to short-term splint support of 3 weeks 1, 2
Evidence for 3-Week Immobilization Protocol:
- Conservative therapy involving immobilization for 3 weeks has proven successful for dorsal chip fractures of the triquetrum 1
- The literature supports immobilization duration of 3-6 weeks, with 3 weeks being adequate for uncomplicated cases 3, 2
- Radiographic union typically takes 6-8 weeks, but clinical healing (pain-free, functional ROM) precedes complete radiographic union 1
Why Radiographic Persistence of the Chip is Not Concerning
- The presence of the dorsal chip fragment at 3 weeks does not indicate treatment failure when clinical parameters are excellent 1
- Complete radiographic healing lags behind clinical healing by several weeks 1
- No indication exists for surgical intervention in dorsal chip fractures, even with persistent fragments 1
- All fractures involving the main body of the triquetrum unite with conservative treatment 1
Active Mobilization Protocol
- Initiate active finger and wrist motion exercises immediately upon splint discontinuation 4
- Early mobilization prevents the most functionally disabling complication: joint stiffness 4, 5
- Active motion does not adversely affect adequately stabilized fractures at this timepoint 6
Reassurance Points for This Patient
No Risk of Instability or Avascular Necrosis:
- Studies demonstrate no signs of post-traumatic instability following conservative treatment of dorsal chip fractures 1
- Good vascularization of the triquetrum excludes the possibility of avascular necrosis 1
- Complications such as non-union are extremely rare in dorsal chip fractures, with only isolated case reports in the literature 3, 7
Non-Compliance with Splint is Not Problematic at This Stage:
- The patient's inconsistent splint use has not resulted in adverse outcomes, as evidenced by pain-free status and good ROM 1
- At 3 weeks post-injury with excellent clinical parameters, the fracture has achieved sufficient stability 1, 2
Follow-Up Recommendations
- No routine radiographic follow-up is necessary given the excellent clinical status 6, 8
- Radiographs should only be obtained if clinically indicated by: new trauma, pain score >6/10, loss of range of motion, or neurovascular symptoms 6, 8
- Clinical follow-up at 6 weeks to confirm continued pain-free status and full ROM is reasonable but not mandatory 1
Critical Pitfall to Avoid
- Do not pursue surgical intervention or prolonged immobilization based solely on radiographic appearance of a persistent chip fragment when the patient is asymptomatic 1
- Dorsal chip fractures are benign injuries that heal with conservative management, and surgical treatment has no role 1, 9
- Prolonged immobilization beyond 3 weeks in an asymptomatic patient risks unnecessary stiffness and muscle atrophy, which occur in approximately 14.7% of immobilization cases 6, 8