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Guo RC, Cardenas JM, Wu CH. Triquetral Fractures Overview. Curr Rev Musculoskelet Med 2021; 14:101-106. [PMID: 33483875 PMCID: PMC7991068 DOI: 10.1007/s12178-021-09692-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE OF REVIEW The triquetrum is the second most commonly fractured carpal bone, comprising 15-18% of all carpal bone fractures. This review summarizes the current knowledge of triquetral fractures, including the anatomy and pathophysiology, evaluation and diagnosis, treatment and management, post-treatment outcomes, and complications. RECENT FINDINGS Triquetral fractures are frequently caused by impaction of the ulnar wrist after a fall on an outstretched hand or by avulsion of attached ligaments. There are three main types of triquetral fractures: dorsal cortical fractures, triquetral body fractures, and volar cortical fractures. Dorsal cortical fractures are the most common and are usually benign, while volar cortical fractures are the least common and can be problematic. Nonsurgical management is indicated for most triquetral fractures, which usually results in good outcomes. Surgical treatment is indicated for fractures with significant displacement or evidence of instability. Complications of triquetral fractures include non-union, triangular fibrocartilage complex injury, and pisotriquetral arthritis. While less common than scaphoid fractures, triquetral fractures should remain in the differential diagnosis for patients with ulnar-sided wrist pain after falling on an outstretched hand. Most triquetral fractures can be treated with immobilization, though they should be thoroughly evaluated due to their potential to result in instability, loss of motion, and arthrosis. Further research is needed to determine the best method of surgical treatment.
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Affiliation(s)
- Raymond C. Guo
- Department of Orthopedic Surgery, Baylor College of Medicine, 7200 Cambridge Street, Houston, TX 77030 USA
| | - Justin M. Cardenas
- Department of Orthopedic Surgery, Baylor College of Medicine, 7200 Cambridge Street, Houston, TX 77030 USA
| | - Chia H. Wu
- Department of Orthopedic Surgery, Baylor College of Medicine, 7200 Cambridge Street, Houston, TX 77030 USA
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Carratalá Baixauli V, Pereira AD, Lucas García FJ, Guisasola Lerma E, Martínez Andrade C. Arthroscopic Pisiform Excision in Pisotriquetral Osteoarthritis Technique Using a Direct Pisotriquetral Portal. Tech Hand Up Extrem Surg 2021; 25:264-268. [PMID: 33782357 DOI: 10.1097/bth.0000000000000345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Pisotriquetral (PT) joint arthritis is a common cause of ulnar-sided wrist pain. Open pisiform excision is a well-established procedure and is indicated when the conservative treatment fails. Although arthroscopic visualization of the PT joint is part of the routine examination in a patient with ulnar-sided wrist pain, therapeutic arthroscopy of the PT joint is limited to one case in the literature through the standard dorsal portals. Arthroscopic pisiform excision is a novel technique described by the authors. The first aim of this procedure is pain relief maintaining wrist stability and strength. With this minimally invasive approach we believe that preserving the flexor carpi ulnaris and the PT ligament complex we maintain their biomechanical function, while at the same time, reducing scar tenderness and postoperative discomfort with better esthetic results and less recovery time. In addition to standard dorsal portals, a direct PT portal was used to have access to the PT space and as a working portal to complete the pisiform excision.
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Affiliation(s)
| | - Ana Daniela Pereira
- Orthopedics and Traumatology Service, Centro Hospitalar de Leiria, Leiria, Portugal
| | | | | | - Cristóbal Martínez Andrade
- Hand and Upper Limb Surgery Unit, Hospital Quirónsalud Valencia, Valencia
- Traumaunit. Teknon Clinic, Barcelona, Spain
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Abstract
Fractures of the carpus can be debilitating injuries and often lead to chronic pain and dysfunction when not properly treated. Although scaphoid fractures are more common, fractures of the other carpal bones account for nearly half of all injuries of the carpus. Often missed on initial presentation, a focused physical examination with imaging tailored to the suspected injury is needed to identify these fractures. In addition to plain radiographs, advanced imaging such as CT and MRI are helpful in diagnosis and management. Treatment of carpal fractures is based on the degree of displacement, stability of the fracture, and associated injuries. Those that require surgical fixation often affect the congruency of the articular surfaces, are unstable, are at risk for symptomatic nonunion, are associated with notable ligamentous injury, or are causing nerve or tendon entrapment. Surgical strategies involve percutaneous Kirschner wires, external fixation, screws and/or plates, excision, or fusion for salvage. Owing to the intimate articulations in the hand, small size of the carpal bones, and complex vascular supply, carpal fracture complications include symptomatic nonunion, osteonecrosis, and posttraumatic arthritis.
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Treatment of a symptomatic triquetral nonunion. CURRENT ORTHOPAEDIC PRACTICE 2019. [DOI: 10.1097/bco.0000000000000767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Athanasiou V, Panagopoulos A, Iliopoulos ID, Vrahnis I, Diamantakis G, Kraniotis P, Tyllianakis M. Intra-articular Fracture of the Distal part of the Triquetrum within the Pisotriquetral Joint: Case Report and Review of Literature. Open Orthop J 2018; 12:84-90. [PMID: 29619121 PMCID: PMC5859460 DOI: 10.2174/1874325001812010084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 02/20/2018] [Accepted: 02/24/2018] [Indexed: 11/22/2022] Open
Abstract
Background Intra-articular fractures of the distal part of the triquetrum within the pisotriquetral joint are uncommon, and can be associated with tears of the dorsal carpal ligaments, pisiform subluxation and/or FCU dislocation. Their diagnosis is difficult and requires a high clinical suspicion and a proper radiological examination including oblique wrist x-rays, computed tomography and MRI scan. These fractures can be delayed diagnosed due to late presentation thus leading to painful nonunion, persistent instability and late pisotriquetral arthritis. Case Report We present a case of a 40-year-old male who complained about ulnarsided wrist pain after a fall on his extended wrist during bicycling. The diagnosis of triquetrum fracture was suspected on clinical examination and confirmed using standard and oblique radiographs and CT scan evaluation. He was immobilized in a short-arm cast for 6 weeks followed by a progressive return to wrist motion and subsequent strengthening for another 5 weeks. He reported complete resolution of pain and excellent wrist motion and function one year after the injury, demonstrating a Mayo score of 100. Conclusion Isolated intra-articular fractures of the triquetrum within the pisotriquetral joint are rare injuries and may constitute a subcategory of body fractures other than the dorsal cortical (chip), main body and volar lip avulsion fractures. Early clinical suspicion and proper imagine can lead to a successful outcome.
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Affiliation(s)
- V Athanasiou
- Department of Hand Surgery, Orthopaedic Clinic of Patras University Hospital, Patras, Greece
| | - A Panagopoulos
- Department of Hand Surgery, Orthopaedic Clinic of Patras University Hospital, Patras, Greece
| | - I D Iliopoulos
- Department of Hand Surgery, Orthopaedic Clinic of Patras University Hospital, Patras, Greece
| | - I Vrahnis
- Department of Hand Surgery, Orthopaedic Clinic of Patras University Hospital, Patras, Greece
| | - G Diamantakis
- Department of Hand Surgery, Orthopaedic Clinic of Patras University Hospital, Patras, Greece
| | - P Kraniotis
- Department of Hand Surgery, Orthopaedic Clinic of Patras University Hospital, Patras, Greece
| | - M Tyllianakis
- Department of Hand Surgery, Orthopaedic Clinic of Patras University Hospital, Patras, Greece
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Pan T, Lögters TT, Windolf J, Kaufmann R. Uncommon carpal fractures. Eur J Trauma Emerg Surg 2015; 42:15-27. [PMID: 26676306 DOI: 10.1007/s00068-015-0618-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 11/30/2015] [Indexed: 11/28/2022]
Abstract
Fractures of the hand are frequently encountered with injuries to the phalanges and metacarpals comprising the vast majority. Fractures of the carpal bones excluding the scaphoid, however, are fairly uncommon. Despite the rarity of fractures of the remaining seven carpal bones, they can cause a disproportionate amount of morbidity from missed diagnosis due to their subtlety as well as their frequent association with significant ligamentous disruption or even other carpal bone fractures. Delayed diagnosis can result in inadequate fracture care, which places the wrist at risk of disabling sequelae. This review focuses on the current concepts of pathophysiology, diagnosis, and treatment of carpal fractures other than the scaphoid.
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Affiliation(s)
- T Pan
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Pittsburgh, PA, USA.
| | - T T Lögters
- Department of Trauma and Hand Surgery, University Hospital Duesseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - J Windolf
- Department of Trauma and Hand Surgery, University Hospital Duesseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - R Kaufmann
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Pittsburgh, PA, USA
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Moraux A, Lefebvre G, Pansini V, Aucourt J, Vandenbussche L, Demondion X, Cotten A. Pisotriquetral joint disorders: an under-recognized cause of ulnar side wrist pain. Skeletal Radiol 2014; 43:761-73. [PMID: 24687844 DOI: 10.1007/s00256-014-1848-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 01/15/2014] [Accepted: 02/10/2014] [Indexed: 02/02/2023]
Abstract
Pisotriquetral joint disorders are often under-recognized in routine clinical practice. They nevertheless represent a significant cause of ulnar side wrist pain. The aim of this article is to present the main disorders of this joint and discuss the different imaging modalities that can be useful for its assessment.
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Affiliation(s)
- A Moraux
- Service d'Imagerie Musculo-Squelettique, Centre de consultation de l'appareil locomoteur, Hôpital Roger Salengro, 2 Bd du Pr E. Laine, CHRU Lille, 59037, Lille Cedex, France,
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Herzberg G. [Chronic ulnar wrist pain in adults: diagnosis and treatment principles]. CHIRURGIE DE LA MAIN 2011; 30:313-22. [PMID: 22030264 DOI: 10.1016/j.main.2011.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Accepted: 09/21/2011] [Indexed: 12/01/2022]
Abstract
Adult patients with chronic ulnar wrist pain often seek medical advice. There are a number of diagnoses for chronic ulnar-sided wrist pain. A sound diagnostic strategy is therefore of paramount importance. Patient's history, clinical examination and high quality standard radiographs are the most important part of this strategy. Sophisticated investigations should only be performed to focus on solid clinical hypotheses. The palmar and dorsal aetiologies of ulnar wrist pain are considered as well as their treatment principles.
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Abstract
Carpal bone fractures make up a significant proportion of injuries to the wrist. The complex bone shape and articulations make diagnosis more difficult and missed injuries more common. This article reviews carpal bone fractures excluding the scaphoid.
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Affiliation(s)
- Steven Papp
- Department of Orthopaedic Surgery, University of Ottawa, Ottawa Civic Hospital, Ottawa, Ontario, Canada K1Y 4E9.
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Abstract
A wide range of hand and wrist injuries occur in today's recreational and elite athletes and account for 3% to 9% of all sports injuries. The onus is on the physician to discriminate between injuries that can be managed with an early return to sport, and those injuries that place the athlete at risk of further injury if they are not managed aggressively from the outset. The physician and the athlete must understand the balance between safe, early return to sport, and prompt surgical treatment that prevents late disability.
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Affiliation(s)
- Jeffrey Marchessault
- Department of Orthopaedic Surgery, Allegheny General Hospital, 1307 Federal Street, 2nd Floor, Pittsburgh, PA 15212, USA.
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Katolik LI. Arthroscopic resection of pisotriquetral joint loose body: a case report. J Hand Surg Am 2008; 33:206-9. [PMID: 18294541 DOI: 10.1016/j.jhsa.2007.10.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2007] [Revised: 10/27/2007] [Accepted: 10/31/2007] [Indexed: 02/02/2023]
Abstract
Pisotriquetral disease is a key element in the differential diagnosis of ulnar-sided wrist pain. A loose body within the pisotriquetral joint is an uncommon entity. After appropriate diagnosis, arthroscopic removal is a feasible alternative to open resection.
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Affiliation(s)
- Leonid I Katolik
- The Philadelphia Hand Center, P.C., King of Prussia, PA 19046, USA.
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Abstract
Carpal bone fractures make up a significant proportion of injuries to the wrist. The complex bone shape and articulations make diagnosis more difficult and missed injuries more common. This article reviews carpal bone fractures excluding the scaphoid.
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Affiliation(s)
- Steven Papp
- Department of Orthopaedic Surgery, University of Ottawa, Ottawa Civic Hospital, 1053 Carling Avenue, Ottawa, Ontario, Canada K1Y 4E9.
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