Volar Dislocation of the Triquetrum - Case Report and Review of Literature

Abstract

In contrast to triquetral fractures, dislocations of the triquetrum are very uncommon because of the very strong ligamentous support. They occasionally occur in association with complex wrist injuries, isolated dislocations however are extremely rare. We report a case of a male athlete who sustained an isolated volar dislocation of the triquetrum. The injury was treated by open reduction, fixation with Kirschnerwires and direct repair of torn ligaments. Kirschner-wires were removed after 6 weeks and physiotherapy was started. At 3 years follow-up he reported to be free of pain and showed only slightly restricted grip strength and range of motion when compared to his uninjured hand. A review of the literature indicates that final outcomes are usually satisfactory if prompt diagnosis and treatment occurs. However persistent pain and impaired hand function may result because of delayed diagnosis or insufficient repair of associated ligament injuries.

Luxación aislada del piramidal

“…Hemos encontrado en la literatura solo 6 casos de luxaciones aisladas del piramidal [6][7][8][9][10][11] , con desplazamiento del hueso hacia dorsal o volar, con una incidencia similar de ambos tipos. Aunque esta lesión se referencia como una luxación aislada del piramidal, suele haber un desplazamiento asociado del pisiforme en mayor o menor grado, como ocurrió en nuestro caso, perdiéndose la congruencia de las superficies articulares de ambos huesos a nivel de la articulación pirámido-pisiforme, lo que cuestiona la validez de denominar estas lesiones como luxación aislada del piramidal.…”

“…Si se diagnostica precozmente, puede optarse por la reducción cerrada bajo anestesia y la inmovilización enyesada, aunque algunos autores prefieren directamente la reducción abierta y estabilización con agujas [9][10][11] . Si el diagnóstico es tardío pero no ha transcurrido demasiado tiempo, una delicada reducción abierta y estabilización con agujas suele ser posible, y con buenos resultados funcionales 7,8 .…”

An uncommon case of traumatic pisiform dislocation with triquetral fracture

“…Cases of isolated pisiform dislocation, pisiform dislocation occurring concurrently with distal radius and triquetral fractures, and pisiform dislocation complicated by ulnar nerve and median nerve injuries have been described in the published literature, albeit none with MRI imaging correlation [5,[7][8][9][10][11]. Dislocation of pisiform bone has also been reported with adjacent triquetral dislocation [12].…”

“…This includes fractures of the ulnar styloid process, the hook of hamate, pisiform, triquetrum, and the base of fifth metacarpal bone [15,16]. Though extremely rare, dislocation of triquetrum must also be considered in the differential [12]. Other differentials include triangular fibrocartilage complex (TFCC) injury, lunotriquetral ligament injury, and subluxation or dislocation of Extensor Carpi Ulnaris (ECU) tendon [15,16].…”

“…Triquetrum is the second most common carpal bone to fracture accounting for 20-30% of all carpal bone fractures [12]. The most common mechanism is due to fall onto an outstretched hand.…”