A triquetrum fracture is a break of one the small bones of the wrist. It usually referred to as a triquetral fracture. It is not an uncommon injury and usually heals well. However, it can have complications depending on the extent of the injury. Read on to learn about a triquetrum fracture. Let’s start with anatomy!
The wrist
The wrist is made up of 3 joints. These include the distal radioulnar joint, radiocarpal joint, and the midcarpal joint. The distal radioulnar joint is made up of the ends of the forearm bones, the radius and ulna, at the wrist. This joint is essential for supination and pronation. Pronation is rotating the forearm, so the palm faces downward, and supination is forearm rotation where the palm faces upward.
The radiocarpal joint is made up of the radius and the first row of carpals. Carpals are the small wrist bones in between the forearm bones and the hand bones. The first row of carpals includes the scaphoid, lunate, and triquetrum. The pisiform is also in this row of carpals, but it is not part of the joint. It sits on top of the triquetrum. This joint is the dominant joint for wrist extension. It assists in wrist flexion, radial deviation, and ulnar deviation.
Wrist extension is when the back of the hand moves toward the back of the forearm. Wrist flexion is when the palm of the hand moves toward the forearm. Radial deviation is when the hand moves to the thumb side. Ulnar deviation is when the hand moves towards the little finger side.
The midcarpal joint is the joint made up of the first and second row of carpals. The second row of carpals include the trapezium, trapezoid, capitate, and the hamate. This joint assists in wrist extension and ulnar deviation. It is the dominant joint for wrist flexion and radial deviation.
What is a triquetrum fracture?
A triquetral fracture is a break of the triquetrum carpal bone. It usually occurs as the result of a fall on an outstretched arm. This is called a FOOSH injury. However, injury to the triquetrum can also be the result of direct trauma, wrist instability, impingement from the ulna, or a strong pull from a ligament. The triquetrum is the second most common carpal bone fracture. The scaphoid is the most common.
A break of the triquetrum can occur without injury to other structures. However, tears of the surrounding ligaments occur with most triquetral fractures. Other injuries that could occur include wrist instability, ulna fracture, radius fracture, or scaphoid fracture.
What are the symptoms of a triquetrum fracture?
There are several symptoms associated with a triquetral fracture. These include:
- Pain on the pinky finger side of the wrist
- Swelling on the pinky finger side of the wrist
- Pain with wrist movements
- Deformity of the wrist
Will I need surgery?
The good news is that most of these fractures can be treated without surgical intervention. The wrist will be immobilized in a splint or cast for 4-6 weeks. Surgery would be needed for those fractures with significant displacement and possible instability.
Potential Complications
- Nonunion – Nonunion means that the fracture is not healing and there is little chance of it healing without surgical intervention. However, most triquetral fractures do well even without a full bony union.
- Triangular fibrocartilage complex injury (TFCC) – The TFCC is a complex of ligaments on the pinky finger side of the wrist. It stabilizes the wrist bones and attaches the ulna and radius together at the wrist. A tear of the TFCC can usually recover with physical therapy.
- Pisotriquetral arthritis – This is the breakdown of articular cartilage between the pisiform and the triquetrum. It can cause swelling and pain in the area.
- Persistent carpal instability – This is an instability of the wrist which can lead to pain and weakness. In some instances, it could lead to dislocation of some of the carpal bones.
Who should I see?
- Physician – If you suspect that you have sustained a triquetral fracture (or some other type of fracture), it is best to go to the emergency room. Because of the potential complications, this fracture should be treated quickly. However, if your fracture has already been treated and you suspect additional injury or complication, then it would be best to see your orthopedist or primary care physician. Additional imaging and inspection might be needed to rule out other conditions.
- Physical therapist – Physical therapy will be needed to regain mobility and strength in the wrist. This will be true whether or not surgery was needed. Because of the extended time in the cast, the wrist will be stiff and sore when trying to move or use it. Your PT can evaluate you to determine the extent of your mobility and strength deficits and use manual therapy, as well as, stretching and strengthening to help address all problems in and around the wrist.
What can I do?
- Relative rest – Resting the area to decrease further pain and damage from occurring is one of the best ways to allow the bones to heal. If you are not able to participate in your activity or sport, then you can supplement with non-irritating activities such as walking or jogging while your wrist is healing.
- Ice – Ice can help decrease pain and symptoms at the wrist. Ice the painful area for 15 to 20 minutes at a time. I would recommend using an ice pack several times per day if the pain is constant or is preventing you from participating in an activity. Ice immediately after activity.
- The following are activities that you can do after the cast is removed or you are cleared by your surgeon.
- Wrist flexion and extension stretching – You will need to stretch out the wrist flexors and extensors.This will feel very tight and sore at first. Begin with a gentle stretch. You can stretch more aggressively as the soreness subsides. See the video below.
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- Wrist strengthening – It is important to strengthen the wrist after a long period of immobilization. Begin with low to no resistance and slowly increase as it becomes easier. You should have minimal pain when performing the exercise and no pain afterwards. Below is a video showing how to strengthen the wrist using resistance bands.
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- Grip strengthening – Strengthening the muscles for gripping is important since a triquetrum fracture syndrome can affect this action. Performing gripping exercises is helpful for recovering hand strength. See the video below.
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- Strengthening the muscles around the elbow and shoulder – Strengthening the muscles around the elbow and shoulder are also important in being able to return to your activity. Decrease your resistance or number of repetitions if you are having pain in the wrists. Using loop resistance bands, dumbbells, or resistance bands can increase strength and difficulty. See the videos below.
In review
- The wrist is made up of 3 joints.
- These include the distal radioulnar joint, radiocarpal joint, and the mid carpal joint.
- Carpals are the small wrist bones in between the forearm bones and the hand bones.
- The triquetrum is one of the 8 carpal bones.
- It is important in wrist motion and stability.
- A triquetral fracture is a break of the triquetrum bone.
- This is usually the result of a fall on an outstretched hand.
- There are several symptoms of a triquetrum fracture including pain at the wrist, tenderness at the pinky finger side of the wrist, and decreased wrist motion.
- There are several complications that could occur including TFCC tear and arthritis.
- Surgery is not usually needed.
- There are things that you can do.
- Rest
- Ice
- After surgery or cast is removed
- Wrist flexion and extension stretching
- Wrist strengthening
- Grip strengthening
- Elbow and shoulder strengthening
As always, If you have questions about the content of this post or any other musculoskeletal questions, please e-mail me.
Additional resources
https://www.orthobullets.com/hand/322147/triquetrum-fracture
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7991068/