Carpal Bone Fractures Research Articles

Successful surgical management of a Salter-Harris type I fracture of the accessory carpal bone in a dog.

To describe the successful surgical management of a previously unreported Salter-Harris type I fracture of the accessory carpal bone in a dog. An 11-week-old intact female Golden Retriever-Poodle cross presented with a history of a marked left forelimb lameness following a suspected fall from a height. On physical examination, the patient demonstrated a severe left forelimb lameness and pain on palpation and range of motion of the left carpus. Orthogonal radiographs of the distal left forelimb demonstrated a type I Salter-Harris fracture of the accessory carpal bone with proximal displacement of the palmar fragment. The patient underwent open reduction and internal fixation wherein the fracture was reduced and stabilized with two 1.1-mm Kirschner wires. Postoperatively, the patient was initially managed with a carpal flexion bandage for 2 weeks and then a soft padded bandage was maintained until 4 weeks postoperatively. The patient recovered well and was walking and weight-bearing comfortably following removal of the carpal flexion bandage. Repeat radiographs performed 4 and 8 weeks postoperatively demonstrated adequate fracture healing but showed mild proximocaudal implant displacement. Implant removal was not performed, as the patient was doing well at home and the implant migration appeared static and was not causing clinical morbidity. To the authors' knowledge, this was the only reported case of a Salter-Harris fracture of the accessory carpal bone in a dog and the only described case of successful surgical stabilization.

Transradial Trans-Scaphoid Transcapitate Transtriquetral Perilunate Dislocation of the Wrist

Abstract Perilunate dislocation is a severe complex injury associated with carpal bone fracture. The most common pattern is trans-scaphoid perilunate dislocation. A transradial, trans-scaphoid, transcapitate, and transtriquetral perilunate dislocation pattern, an extremely rare complex injury of the wrist joint, may be the first reported case of a combination of three carpal bone fractures and radial styloid fracture associated with perilunate dislocation.

Endoscopic diagnosis of an obstructive fungal ball in the urethra of a dog

AbstractA 1‐year‐old, male, neutered German shepherd dog was presented for a chronic atraumatic non‐healing fracture of the right accessory carpal bone, stranguria and polyuria/polydipsia. Biochemistry and urinalysis showed azotaemia. Ultrasound and computed tomography of the abdomen both demonstrated bilateral renal infarcts with pyelectasia, bilateral ureteral dilation and bladder distension. Cystoscopy of the bladder identified a fungal ball obstructing the pelvic urethral sphincter, which was adhered to the bladder mucosa in the region of the ureterovesicular junction. The obstruction was traversed endoscopically, but could not be removed transurethrally. The combination of elevated serum galactomannan titres (6.4) and Aspergillus terreus cultured from urine, confirmed a diagnosis of disseminated aspergillosis. The dog was euthanased due to poor quality of life, guarded prognosis and lengthy timeframe before an expected medical response. This is the first case report describing Aspergillus fungal balls in a dog causing partial urethral and bilateral ureteral obstruction, identified using cystoscopy.

PANORAMIC REVIEW OF ACUTE SCAPHOID FRACTURES: DESCRIPTION, EPIDEMIOLOGY, ETIOLOGY, PRESENTATION, DIAGNOSIS, TREATMENT AND PROGNOSIS

Introduction: Scaphoid fractures are the most common fractures of the carpal bone and commonly occur in young males. Inadequate treatment of these fractures commonly leads to pseudarthrosis, resulting in pain and significant disability. Tenderness to palpation and/or pain with axial loading of the thumb should be managed as if it were a scaphoid fracture until proven otherwise. Objective: to detail current information related to scaphoid fractures, description, epidemiology, etiology, presentation, diagnosis, treatment and prognosis. Methodology: a total of 37 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 20 bibliographies were used because the other articles were not relevant to this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: fracture, scaphoid, carpal bones, trauma, surgery. Results: Scaphoid fractures account for 2% to 7% of all fractures and 60% to 70% of carpal bone fractures. They are infrequent in children with approximately 3% of all pediatric hand and wrist fractures. Non-displaced fractures have high healing rates with cast treatment. Radiographs may miss fractures up to 25% of the time. Physical therapy is important in both operative and nonoperative treatment. Conclusions: Knowledge of the clinical presentation, diagnosis and treatment of scaphoid fractures is of utmost importance, because sometimes this type of fracture can go undetected on radiographs, which can lead to complications such as pseudarthrosis. The diagnosis of scaphoid fractures is sometimes complicated, so when there is clinical suspicion, appropriate complementary examinations should be performed to better determine the pathological condition, as is the case of computed tomography. Conservative or surgical management will depend on the type of fracture. Smoking cessation is recommended to improve fracture healing and physiotherapy both after surgical and non-surgical treatment. KEY WORDS: fracture, scaphoid, carpal bones, trauma, surgery.

Review of extraosseous and intraosseous blood supply of the carpal bones

The blood supply of the carpal bones has been updated and described with new dissection, vascular filling and imaging techniques. It is very important to know the vascular anatomy of the carpal bones in order to predict vascular insufficiency and associated avascular necrosis that may occur as a result of any injury such as fracture. This article reviews the extraosseous and intraosseous vascular supply of the carpal bones. The carpal bones are supplied by three vascular arches formed by the radial, ulnar and anterior interosseous arteries on the dorsal and palmar sides of the wrist. These contribute to the dorsal and palmar carpal vascular systems, which consist of transverse arteries connected by longitudinal anastomoses. The scaphoid and capitate have a high risk of avascular necrosis, while the trapezium, triquetrum, pisiform and 80% of the lunate have a lower risk. With the development of new imaging techniques, new information is added to the literature. With the increase in three-dimensional studies, intraosseous vascularity and its correlation with carpal bone fractures and its relationship with avascular necrosis will be revealed more clearly.

Spontaneous union of neglected proximal pole scaphoid fracture: A case report

Scaphoid fractures are the most common carpal bone fractures and usually occur due to trauma, typically a fall on an outstretched hand. The scaphoid bone is integral to wrist biomechanics, linking the proximal carpal row to the distal row. Neglected scaphoid fractures can lead to significant long-term complications, with degenerative changes likely to occur. The most common consequence of a neglected scaphoid fracture is known as scaphoid non-union advanced collapse, which typically begins within five years following the injury. It is widely accepted that scaphoid fractures, in general, should be treated to avoid long-term complications. Many surgeons aggressively treat proximal pole fractures with surgical fixation due to the high risk of avascular necrosis. Although some surgeons may consider a period of immobilization, none would argue against the need for treatment of proximal pole fractures, either through immobilization or surgical fixation. In this case, we present an instance of spontaneous union of a neglected proximal pole fracture non-union in a mature adult. This report aims to provide awareness of the possible spontaneous union of neglected proximal pole scaphoid fracture. It also challenges the call for acute aggressive surgical intervention in such fractures. Radiographs and magnetic resonance imaging scan images before and after union are presented, along with a review of the available literature.

Radiofrequency Ablation of Palmar Digital Branches of Ulnar Nerve in a Patient with Ulnar Neuropathy

Ulnar Tunnel Syndrome (UTS) is ulnar neuropathy at the wrist or hand typically caused by ganglion cysts, lipomas, wrist or hand compression, carpal bone fractures, carpal tunnel syndrome, or anything else that can impinge on the nerve. The symptoms of UTS can be uncomfortable and debilitating, with numbness and tingling of the 4th and 5th digits being the most common. Weakness of the ulnar portion of the hand can lead to decreased grip strength. UTS is typically managed with conservative treatment including anti-inflammatory oral medications, splinting, physical therapy, activity modification, acupuncture, and stretching. Second line treatment includes corticosteroid injections, although these have shown to have little efficacy. Surgery is also an option but may lead to iatrogenic ramifications. Radiofrequency ablation (RFA) is a treatment modality used for chronic pain, which utilizes heat to target nociceptive fibers. Traditionally, RFA is used in treating cervical and lumbar radiculopathy, but it is less studied in peripheral nerve areas. This case report examines a patient who had clinically significant pain relief after RFA to the palmar digital branches of the ulnar nerve. The patient was 63-year-old male who presented with left ulnar neuropathy that had been ongoing for 3 years. Despite conservative management, his symptoms of pain, paresthesia, and weakness persisted. The patient then elected to have a left cubital tunnel release at the elbow with anterior subcutaneous transposition. The surgery provided relief for three months but then led to worsening contractures and pain in the 4th and 5th digits of the left hand. Due to persistent symptoms after conservative management and surgical intervention, he was referred to interventional pain clinic. A decision was made to trial a digital nerve block of the left medial and lateral digital palmar nerves. Following the nerve block, the patient reported 100% improvement in pain and increased range of motion and function. Four weeks later, the patient returned for a radiofrequency ablation of the same nerves. In the week following the procedure, the patient reported that the pain in the little finger was entirely resolved. While radiofrequency ablation has become increasingly popular for the treatment of chronic back pain, its use in peripheral nerve pain has been limited to case reports and few randomized control trials. This case report highlights the successful use of radiofrequency ablation in the treatment of little finger pain and ulnar neuropathy by targeting the median and lateral branches of the palmar digital nerve.

Application of Artificial Intelligence and Machine Learning in Diagnosing Scaphoid Fractures: A Systematic Review.

The integration of artificial intelligence (AI) in healthcare has sparked interest in its potential to revolutionize medical diagnostics. This systematic review explores the application of AI and machine learning (ML) techniques in diagnosing scaphoid fractures, which account for a significant percentage of carpal bone fractures and have important implications for wrist function. Scaphoid fractures, common in young and active individuals, require an early and accurate diagnosis for effective treatment. AI has the potential to automate and improve the accuracy of scaphoid fracture detection on radiography, aiding in early diagnosis and reducing unnecessary clinical examinations. This systematic review discusses the methods used to identify relevant studies, including search criteria and quality assessment tools, and presents the results of the selected studies. The findings indicate that AI-driven methods can improve diagnostic accuracy, reducing the risk of missed fractures and complications. AI assistance can also alleviate the workload of medical professionals, improving diagnostic efficiency and reducing observer fatigue. However, challenges such as algorithm limitations and the need for continuous refinement must be addressed to ensure reliable fracture identification. This review underscores the clinical significance of AI-assisted diagnostics, especially in cases where fractures may be subtle or occult. It emphasizes the importance of integrating AI into medical education and training and calls for robust data collection and collaboration between AI developers and medical practitioners. Future research should focus on larger datasets, algorithm improvement, cost-effectiveness assessment, and international partnerships to fully harness the potential of AI in diagnosing scaphoid fractures.

Arthroscopic Volar Capsuloligamentous Reattachment and Reinforcement to Bone.

Background: Injuries of the volar ligaments of the wrist are not uncommon, but their arthroscopic treatment presents a significant challenge. The objective of this paper is to introduce a technique for reattaching (in acute injuries) or reinforcing (in chronic injuries) various volar wrist ligaments to the bone, using standard wrist arthroscopic dorsal and volar portals. Methods: There are three common steps for all the arthroscopic volar capsuloligamentous reattachments or reinforcements Step 1 - Volar Portal Establishment: volar radial, volar ulnar and volar central portals are used depending on which structure needs to be reattached or reinforced. Step 2 - Anchor Placement: the anchor is positioned at the site where the ligament has been detached. Step 3 - Capsuloligamentous Suture and Knotting: a knot pusher is introduced inside the joint from the dorsal portal and advanced inside the volar portal where the threads of the anchor are located. The knot pusher is loaded with the threads and retrieved to the dorsal portal. A 16G Abbocath, loaded with a loop is used to pierce the volar ligaments. The loop of the Abbocath is captured from the dorsal portal and loaded with the threads. Both threads are taken to the volar portal and knotted after releasing the traction. This way the knot is placed out of the wrist and the ligaments are reattached or reinforced to the bone. Result: This technique has been used to reinforce and reattach the scapholunate and lunotriquetral ligaments and to reattach the radiocarpal ligaments and the Poirier space. Since this procedure has been performed in various conditions and in conjunction with other ligament treatments (such as perilunate injuries, carpal bone fractures, distal radius fractures, and reinforcement or reattachment of the dorsal portions of intrinsic ligaments), specific results are not presented. Conclusions: The described technique enables the reattachment and reinforcement of most volar ligaments to the bone using standard wrist arthroscopic portals. It can be performed in conjunction with the treatment of the dorsal portion of intrinsic ligaments or other wrist injuries.

MDCT evaluation of distal radius fractures and their association with carpal and distal ulnar fractures.

The purpose of this study was to evaluate the characteristics of distal radius fractures (DRFs) in patients undergoing multi-detector computed tomography (MDCT) and their association with carpal and distal ulnar fractures. This retrospective study analyzed 120 patients, who underwent MDCT for evaluation of DRFs. Two radiologists independently evaluated the data for various fracture characteristics and for associated carpal and distal ulnar fractures. Out of 120 DRFs, 74 were complete articular, 40 were partial articular and only 6 were extra-articular. Displacement was present in 99 fractures and intra-articular step off was present in 73 fractures. A total of 81 carpal bone fractures were identified in 46 (38.3%) patients, with more than one carpal bone fracture in 21 patients. Distal ulnar fractures were detected in 79 patients (65.8%), out of which 67 involved the ulnar styloid. DRFs with intra-articular step off were more frequently associated with carpal bone fracture (p value: 0.021), while displaced DRFs were more frequently associated with distal ulnar fracture (p value <0.001). Interobserver agreement for detection of carpal bone fractures (κ = 0.807) and distal ulnar fractures (κ = 0.923) was excellent. Majority of DRFs in patients referred for MDCT were complete articular with high incidence of displacement and intra-articular step off. Associated carpal bone and distal ulna fractures were not uncommon.

Scaphoid and Carpal Bone Fracture: The Difficult Cases and Approach to Management.

Scaphoid and carpal bone fractures are challenging injuries to manage and have significant functional implications. Prompt diagnosis is important and relies on systematic evaluation via history, examination, and imaging. Cross-sectional imaging is often helpful for diagnosis and treatment planning. Treatment for nondisplaced fractures is often closed but these injuries typically require prolonged immobilization and may still result in nonunion or avascular necrosis. Displaced carpal bone fractures, and those associated with carpal instability, typically require open reduction internal fixation.

Comparison of Radiography and Computed Tomography for Evaluation of Third Carpal Bone Fractures in Horses.

Radiographs underestimate the extent of bone injury in horses with third carpal bone (C3) fractures (Fx). We aimed to describe bone pathologies identified using computed tomography (CT) and compare the diagnostic value of digital radiography (DR) and CT in horses with C3 Fx. CT images of 15 racehorses with C3 Fx and 10 controls were reviewed (Part 1) then DR and CT images of 26 racehorses (24 Thoroughbred, 2 Standardbred) with C3 Fx (Part 2) were evaluated. Agreement on fracture geometry and concomitant bone lesions was tested between DR and CT using the kappa statistic (Part 2). For agreement analysis, 38 limbs were used (27 Fx carpi from 26 horses and 11 contralateral carpi). Intermodality agreement was good for recognition of displacement, fair for comminution, articular surface bone loss and osseous fragmentation, and poor-slight for recognition of whether the Fx was complete, additional fissures and lucencies. CT provides more detailed information than DR regarding bone pathology and fracture configuration in horses with C3 fracture. Correlation of CT findings with clinical information and outcome needs to be explored; however, the more accurate diagnosis possible with CT is likely valuable when deciding on the most appropriate management and for surgical planning.

Trapezial Fractures and Associated Fractures of the Ulnar Carpus: A Ring-Bone Model.

Fractures of the trapezium are rare; however, the incidence may be under-reported in the literature. The incidence of ulnar-sided carpal body fractures as a concomitant injury has not been reported. Our study aimed to evaluate the incidence of trapezium fractures in conjunction with ulnar-sided carpal body fractures. Over a five-year period, our electronic records were queried and charts reporting carpal bone fractures were reviewed. All cases of trapezium fracture were evaluated further and presented. Eight trapezial fractures were identified, representing 8% of all carpal fractures and 26% of all nonscaphoid carpal fractures. Of the eight trapezium fractures identified, five (62.5%) were associated with Bennett fracture and four (50%) were associated with ulnar-sided carpal fractures. Our study demonstrates a higher incidence of trapezial fractures than previously reported. Previously unreported concomitant ulnar-sided carpal body fractures are reported at a frequency nearly equal to that of concomitant Bennett fractures in our series. We propose a mechanism of injury where the carpal canal and overlying transverse carpal ligament function as a ring-bone construct similar to the pelvis. When a trapezium fracture is identified, we recommend additional evaluation for ulnar-sided injuries of the carpus.

Automated detection of scaphoid fractures using deep neural networks in radiographs

The scaphoid is one of the most common carpal bone fractures diagnosed using radiographs. However, occult scaphoid fractures not visible on radiographs make early diagnosis and treatment difficult. Hence, the objective of this study was to develop a high-performing deep-learning model for the detection of apparent fracture and non-apparent occult scaphoid fractures using only plain wrist radiographs. This work used 525 x-ray images, 250 of which were normal scaphoids, 219 were fractured scaphoids, and 56 were occult fracture X-rays. These X-ray images were obtained from the Department of Orthopaedics, Kasturba Medical College’s (KMC), Manipal. A CNN-based deep learning model was developed for two classes (normal VS fracture) and three classes (normal VS fracture VS occult). For fracture localization, gradient-weighted class activation mapping (Grad-CAM) was used. For two-class classification, the proposed CNN model achieved sensitivity, specificity, accuracy and AUC of 92%, 88%, 90% and 0.95, respectively. For three-class classification, the proposed model achieved an overall performance of 85% sensitivity, 91% specificity, 90% accuracy and 0.88 AUC. Wrist radiograph images used to train the model did not undergo a segmentation process, saving time and improving efficiency if implemented in a hospital setting.

Forensic medical characteristics of bone fractures of the hand

BACKGROUND: The forensic medical aspects of closed bone fractures of the hands are important in connection with the need to establish the nature, mechanism of occurrence, severity, and duration of these injuries.&#x0D; AIM: This study aimed to assess the severity of closed bone fractures of the hands based on the features of the formation, course, and outcomes.&#x0D; MATERIAL AND METHODS: Fractures of wrist bones (n = 24) and metacarpal bones (n = 218) were examined in persons struck by blunt objects.&#x0D; RESULTS: Scaphoid bone fractures (81.8%) most often occurred on the side of the carpals, and fractures of other carpal bones are detected relatively less frequently (18.2%). With closed fractures of the navicular bone, especially in cases of late seeking medical help, complications such as a false joint and aseptic necrosis can be observed, causing pronounced radiocarpal joint dysfunction. In the metacarpal bones, periarticular fractures of the proximal epiphysis (49.1%) are often noted, followed by intra-articular fractures (26.6%) and periarticular diaphyseal fractures (20.6%). Complications such as finger contractures in chronic metacarpal bone fractures were most observed in intra-articular, comminuted with mixed, and transverse fractures.&#x0D; CONCLUSION: Isolated uncomplicated closed fractures of wrist bones have moderate severity. Moreover, scaphoid bone fractures, complicated by a false joint and aseptic necrosis, causing severe wrist joint dysfunction, and ultimately joint immobility in a functionally disadvantageous position, according to the criterion of total disability, qualify as severe injury. The severity of the harm caused to the health of complicated and uncomplicated isolated metacarpal fractures can be classified as moderate.

The morphologic and morphometric features of the triquetrum

Fractures of the triquetrum are the second most common form of isolated carpal bone fracture after the scaphoid. However, data on triquetrum morphology and morphometry are sparse. The aim of this study was to describe the morphology of triquetrum using anatomical landmarks, evaluate its morphometric features, and determine its vascular entry points. The morphological and morphometrical features of 87 adult dry triquetral bones (39 left, 48 right) were determined by measuring length, width and thickness. The number and locations of nutrient foramina wider than 0.5 mm were recorded. Mean length, width and thickness were 17.37 mm (range, 14.26–22.13), 12.65 mm (range, 10.37–15.85) and 11.41 mm (range, 8.98–18.23), respectively. The facet articulating with the pisiform was oval in 40 bones, round in 8 and amorphous (neither round nor oval) in 39. The mean length of the interarticular ridge was 7.09 ± 0.9 mm. The mean number of nutrient foramina was significantly greater on the dorsal than on the other aspects. The dorsal predominance of nutrient foramina makes the bone weaker in the dorsal region, which could explain why fractures are more common in this region. Also, the dorsal aspect is rich in blood supply, which could explain why avascular necrosis is less common in triquetral fractures. As most of the vascularization is on the dorsal side, there is need for caution when performing triquetrum surgery. Level of evidenceLevel 2.

Use of Locking Compression Plate and Locking Compression T-Plate for Surgical Arthrodesis of the Carpometacarpal and Distal Tarsal Joints in 13 Horses.

The aim of this study was to describe the use of the locking compression plate (LCP) and locking compression T-plate (LCTP) in cases of carpometacarpal and distal tarsal arthrodesis for the treatment of osteoarthritis and small carpal or tarsal bone fractures, and to document clinical outcomes. Case records of horses treated with carpometacarpal or distal tarsal arthrodesis via internal fixation using an LCP or LCTP between 2013 and 2021 were reviewed. All cases were evaluated retrospectively. Follow-up information was gained via phone conversation with owners and referring veterinarians. Data were collected for 13 horses that fulfilled the study criteria. A total of eight horses underwent distal tarsal arthrodesis, and five underwent carpometacarpal arthrodesis. Twelve of thirteen horses went back to some level of athletic performance. Eight of 13 returned to the same level, while 4 of 13 returned to a lower level. Minor postoperative complications were recorded in 3 of 13 cases, with all horses suffering manageable short-term complications returning to the same level of work. Two horses suffered a major complication, with one resulting in euthanasia. Carpometacarpal and distal tarsal arthrodesis performed using the LCP and LCTP allowed all surviving horses in the study to obtain immediate postoperative comfort and eventual return to use.

Standing osteosynthesis of an accessory carpal bone fracture in a Warmblood mare with a 6‐hole 3.5 talonavicular fusion plate and 3.5‐mm screws

SummaryA 9‐year‐old Warmblood, high‐level showjumping mare sustained an acute, closed, vertical, comminuted fracture of the left accessory carpal bone (ACB) during a fall. The fracture was repaired under standing sedation and local anaesthesia, using a 6‐hole APTUS® 3.5 TFP and 5 × 3.5‐mm self‐tapping TriLock© screws. The mare recovered from surgery without complications. Upon follow‐up examination 9 months post‐operatively the mare was sound in all gaits and back to full athletic activity. The ACB fracture had completely healed. The displaced dorsoproximal fracture fragment was in a stationary position and there was evidence of mild nonprogressive osteoarthritis of the antebrachiocarpal joint.

Biomechanical Comparison of a Headless Compression Screw Fastener and AO Cortical Bone Screw for Fixation of a Simulated Equine Third Carpal Bone Slab Fracture

Frontal plane slab fractures account for the majority of third carpal bone (C3) fractures in racing and performance horses. Recommended treatment is stabilization with a lagged AO cortical screw. Associated complications are fragment splitting, fragment spinning, and irritation of dorsal soft tissue structures. A novel, headless, cannulated screw with interlocking threads the Headless Compression Screw Fastener (HCSF) has been developed to resist multidirectional forces and bending moments; however, it has not been applied in the horse. Simulated C3 frontal plane slab fractures were created in nine paired carpi from equine cadaver limbs, fixed with either the HCSF or AO cortical bone screw, and loaded in shear to failure. The effect of screw type on stiffness, maximum load to failure, and yield load was assessed in separate linear mixed models. No significant (P< .05) difference between screw types was detected in terms of maximum load to failure (P= .084), stiffness (P= .26), or yield load (P= .088). Mode of failure was screw bending in all specimens. For some samples in both groups, failure was associated with the sagittal fracture at the screw-bone interface. The HCSF was successfully used to repair simulated third carpal bone fractures. The different head and thread pitches of the HCSF effectively compressed the fracture. The headless design eliminates the need for counter sinking. There was no significant difference in maximum load to failure, stiffness, nor yield load compared to the cortical screws. These results invite clinical application to be investigated.

Özel Radyografi Bulgusu ile Bilateral Triquetrum Kırığı

A 44-year-old male patient presented to the emergency department with pain in both wrists because of falling. It was learned that both wrists of the patient were in dorsiflexion while falling, and there was no additional injury. The Glasgow coma scale score was 15; vital values were within normal limits. The patient had bilateral wrist tenderness, pain with ulnar deviation, and edema on the dorsal side. In addition, he had pain with palpation of the left snuff box. Examinations of the ulnar and radial nerves and arteries were normal. X-rays showed a triquetrum fracture in the right hand, and a triquetrum and scaphoid fracture in the left hand. While triquetrum fractures were not apparent on anterior-posterior radiographs, they were clearly visible on both lateral radiographs (Figure 1). With a short-arm splint for the right hand and a scaphoid cast for the left hand, the patient recovered without sequelae after 6 weeks of wrist immobilization.&#x0D; Triquetrum fractures are generally classified as dorsal cortex fractures and body fractures. Dorsal cortex fractures are more common and are usually seen as avulsion fractures. They occur with trauma, especially in the form of falling with wrist dorsiflexion. Our patient also fell with the same mechanism. To diagnose triquetrum fractures, lateral and oblique radiographs should be performed in addition to anterior-posterior radiographs. In particular, dorsal cortex fractures may not be visible on the anteroposterior radiograph, while the avulsion fragment is better seen on the lateral radiograph. The appearance of triquetral fractures on the lateral radiograph is called the "pooping duck sign" because of the typical shape it forms with the scaphoid and lunate bone (Figure 2). In our case, although both triquetrum fractures could not be clearly seen on the anterior-posterior radiograph, they were seen more clearly with typical findings on the lateral radiograph. Triquetrum fractures are typical of carpal bone fractures, which can be seen more prominently on lateral radiographs, and knowing the specific finding on the lateral radiograph may help with the diagnosis.