Isolated displaced non-union of a triquetral body fracture: a case report

Abstract

IntroductionFractures of the body of the triquetral bone are the second most common carpal fractures, and these fractures can be missed on plain X-ray. Although non-union of triquetral body fractures is very rare, such cases are associated with considerable morbidity and reduction in functional activity.Case presentationWe report the case of a 29-year-old Caucasian British man who sustained an isolated displaced triquetral body fracture that resulted in non-union, who was treated surgically. We describe an original operative management for this debilitating injury. An open reduction and internal fixation using double headed compression screws was performed, without bone grafting, and with early immobilization of the wrist.ConclusionsWe propose this novel approach and advocate early clinical suspicion of triquetral body fractures in patients with a history of fall on an outstretched hand and ulnar sided wrist pain. We recommend evaluation using computed tomography or magnetic resonance imaging scanning.

Intra-articular Fracture of the Distal part of the Triquetrum within the Pisotriquetral Joint: Case Report and Review of Literature

“…Undisplaced, body fractures, can be treated conservatively with cast immobilization [ 20 ]; in cases of marked displacement open reduction and internal fixation with a compression screw and/or Kirschner wires may be required [ 6 , 22 ]. Non-union is rare but can be successfully treated with late ORIF [ 23 ]. Body fractures rarely occur in isolation and may be a radiographic indication of a higher energy and more severe wrist injury [ 24 ].…”

“…Jeantroux et al [ 26 ] highlighted also the importance of Gd-enhanced FS T1-weighted MRI sequences with wrist pronation and supination in the athletic injuries of the extensor carpi ulnaris subsheath. Nonunion or pseudarthrosis of the triquetrum is rare but can be successfully treated with fragment excision or late internal fixation [ 23 , 27 ]. Painful post-traumatic pisotriquetral arthritis can also occur and can be managed with pisiform excision [ 9 , 28 ].…”

Triquetral Fractures Overview

“…While triquetral body fractures are typically associated with another injury, isolated triquetral body fractures can occasionally occur [24]. Displaced triquetral body fractures have been reported and the underlying cause of the fractures was a fall onto an outstretched hand with the wrist in extension [25,26].…”

“…In the rare instance of a symptomatic non-union, a treatment option could be to excise the fracture fragment as done in hamate fractures [35]. Another option is to consider fixation using headless mini-compression screws [26]. Depending on the fracture pattern, both options appear supported by the literature and can be utilized as deemed appropriate by the treating surgeon [26,35].…”

“…Another option is to consider fixation using headless mini-compression screws [26]. Depending on the fracture pattern, both options appear supported by the literature and can be utilized as deemed appropriate by the treating surgeon [26,35].…”