Fractures Of Triquetrum Research Articles

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.
 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.

Comparison of the diagnostic accuracy of X-ray and computed tomography in patients with wrist injury

BackgroundThis study aimed to compare CT and XR images of patients admitted to the emergency department due to wrist injuries and to evaluate the accuracy of XR in the diagnosis of fractures. MethodsPatients; who admitted to ED with injuries due to wrist trauma and who underwent XR imaging and CT scans in the period from 1 January 2017 to 1 January 2018, were included in the study. CT scan image interpretation reports recorded in the hospital automation system were considered eligible to be included in the study. XR images were interpreted by an orthopedics and traumatology specialist. The sensitivity (Sn), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV) and Kappa (κ) coefficient of XR were calculated according to CT. Inter-rater agreement was graded according to κ values. ResultsA total of 274 patients were included in the study. Fractures were identified in the XR images in 180 (66%) patients and in the CT images in 196 (72%) patients. Compared to CT, the Sn, Sp, PPV, NPV and κ coefficient of XR were 89%, 92%, 97%, 77% and 0.764 respectively. Compared to CT, the highest sensitivity of XR was measured to detecting radius (Sn: 95%, κ: 0.896) and 5th metacarpal fractures (Sn: 77%, κ: 0.859), the lowest sensitivity of XR was calculated in detecting scaphoid, capitate, pisiform, trapezium hamate, and triquetrum fractures (Sn: 59–14%, κ: 0.619–0.240). The sensitivity and κ coefficient of XR were calculated 54% and 0.530 in the adjacent bone fracture, 83% and 0.830 in joint dislocation, 75% and 0.661 in the fractures extending to the joint space. ConclusionsXR is the first-choice imaging modality in the evaluation of wrist injuries, but CT imaging should be preferred when fractures extending to the joint space, adjacent bone fracture and carpal bone fracture are being considered.

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

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.

A Scoring System to Demonstrate the Risk for Bone Injury in Patients with Clinically Suspected or Occult Scaphoid Fracture.

Background:It is important to diagnose a scaphoid fracture accurately and start the correct treatment in the shortest time possible. However, the fracture of bone may not be visible on x-ray. In such cases, patients are clinically diagnosed with suspected or occult scaphoid fractures. The aim of this study was to define a scoring system based on physical examination to demonstrate the risk for bone injury in patients with clinically suspected and occult scaphoid fractures with negative radiographs and anatomical snuff box tenderness and to decrease the costs and workforce loss due to unnecessary treatment and magnetic resonance imaging (MRI).Materials and Methods:Patients were initially evaluated by the attendant orthopedic physician in the emergency service with X-ray of the wrist, and ten wrist physical examination techniques were used. The X-rays of patients were evaluated by three orthopedic surgeons. Finally sixty patients, who were diagnosed as having no fracture by all three orthopedic surgeon, were included in the study. The wrists of these patients were evaluated with MRI.Results:There were 46 male (77%) and 14 female (23%) patients with a mean age of 21.5 years (range 7–61 years). About 3.3% had triquetrum fracture, 15% had bone edema in the scaphoid and radius, 18.3% had distal radius fracture, 31.6% had scaphoid fracture, and 31.8% had no bone injury. A scoring system was also proposed. It can be predicted that in the physical examination of the wrist if the total score is higher than 6.5, the probability of fracture is 2.87 (positive likelihood ratio) fold compared to scores below 6.5.Conclusions:Proposal of this new scoring system was thought to be useful for predicting the risk for bone injury in patients with clinically suspected scaphoid fractures and making decision regarding therapeutic options.

MRI shows a high incidence of carpal fractures in children with posttraumatic radial-sided wrist tenderness

Background and purpose — The epidemiology and optimal diagnostics of wrist injuries in children are not knotwn. We describe fractures revealed by magnetic resonance imaging (MRI) in a prospective population of children and adolescents with posttraumatic radial-sided wrist tenderness, and compare the diagnostic value of radiographs and computed tomography (CT) with that of MRI.Patients and methods — From 2004 to 2007, patients less than 18 years of age who presented at our emergency department were included in the study. 90 wrists in 89 patients underwent clinical, radiographic, and low-field MRI investigation. If plain radiographs or MRI revealed a scaphoid fracture, a supplementary CT scan was performed. Sensitivity and specificity of radiographs and CT for diagnosis of scaphoid fractures was calculated using MRI as the reference standard.Results — 74 fractures were diagnosed in 61 of 90 wrists using MRI; 48 wrists had a scaphoid fracture, 8 had a distal radius fracture, 7 had a capitate fracture, and 3 had a triquetrum fracture. The most common combination of fractures was scaphoid and capitate. The sensitivity of radiographs for visualization of scaphoid fractures was 54% and the specificity was 100%. The sensitivity for other fractures was <50%. The sensitivity of CT for visualization of scaphoid fractures was 96% and it was between 33% and 100% for other fractures.Interpretation — MRI showed a high incidence of fractures in children and adolescents with posttraumatic radial wrist tenderness, and it led to the diagnosis of more fractures than plain radiographs and CT. A scaphoid fracture was the most common carpal injury, followed by fracture of the capitate.

Trapezoid and Triquetrum Fracture: Report of a Rare Fracture Pattern

Trapezoid bone fracture is the least common fracture owing to the fact that it is strictly bounded to scaphoid, capitate and the base of the second metacarpal. Isolated fractures are rarely seen and usually related to the high energy trauma. It is conservatively treated without dislocation. Triquetrum fractures are the second least common fractures among carpal bones. The body fractures are usually caused by a fall onto an open flexed hand. Non-displaced fractures can be treated conservatively. Our aim is to remind those rare fractures of the carpal bones that accompany the wrist trauma, which can require additional radiological studies.

Isolated Triquetrum Fractures: The Importance of Proper Roentgenograms in Ulnar Sided Wrist Pain

Triquetrum fractures are the second most common carpal fractures after scaphoid. However they are seldom encountered due to their clinical symptoms and since they cause less functional disability. They can be misdiagnosed as soft-tissue injuries by considering the similar localization of pain and prolonged symptoms. The majority of triquetrum fractures can be diagnosed with direct X-ray. Obtaining three plane (anterior-posterior, lateral and oblique) X-rays is especially important in diagnosing dorsal chip fractures. Accurate diagnosis provides both controlling the symptoms with adequate immobilization, sufficient information of the patient in the acute period and preventing unnecessary diagnostic work up in the subacute period because of prolonged discomfort. In our study, fifteen patients with isolated triquetrum fractures admitted within six year period were presented with their clinical, radiological features and treatment outcomes.

Lésions péri-lunaires sans luxation – une nouvelle entité

Introduction The purpose of this study was to review a series of equivalents of perilunate dislocations and fractures-dislocations (PLDs-PLFDs) where there was no dislocation of the capitate from the lunate on the initial radiographs. We propose to include these injuries as a PLIND Group of perilunate injuries in a modified perilunate injuries classification. Methods A review of possible PLIND injuries was done in a single academic centre over a 5-year period. All cases presenting at the acute stage with displaced fractures of scaphoid, lunate, triquetrum or capitate along with perilunate gaps but no true dislocation of the capitate from the lunate in the sagittal or coronal planes were retrospectively analyzed. Results We identified 15 patients with PLIND injuries (13 acute and 2 chronic) within the index period. Four cases with clinical and radiological follow-up will be presented. Discussion Equivalents of PLDs-PLFDs presenting without dislocation of the capitate from the lunate do exist. There is currently no specific denomination for these injuries, which may be overlooked despite their severity. Indeed they may need a complex osseous and ligamentous injuries management. Including them into an existing perilunate injuries classification highlights their regognition and allows for a better understanding and treatment of both acute and chronic non-dislocated perilunate injuries.

Perilunate Injuries, Not Dislocated (PLIND)

Purpose We reviewed a series of equivalents of perilunate dislocations and fracture-dislocations (PLDs-PLFDs) in which there was no dislocation of the capitate from the lunate on the initial radiographs. We propose to include these injuries as a variant of perilunate dislocations that we have termed a perilunate injury, not dislocated (PLIND) lesion in a modified classification of perilunate injuries. Methods A review of the records of all acute perilunate injuries and displaced carpal fractures was done in a single-center university hospital wrist surgery unit over a 5-year period. All cases presenting at the acute stage with displaced fractures of scaphoid, lunate, triquetrum, or capitate along with scapholunate and/or lunotriquetral dissociation but no dislocation of the capitate from the lunate in the sagittal or coronal plane were reviewed and considered as PLIND lesions. Results We identified 11 patients with PLIND lesions. Three cases with clinical and radiological follow-up are presented. Discussion Equivalents of PLDs-PLFDs presenting without dislocation of the capitate from the lunate do exist. These injuries may be overlooked despite their severity. They require both osseous and ligamentous repair. Including them into an existing perilunate injuries classification highlights their recognition and enables a better understanding and treatment of both acute and chronic nondislocated perilunate injuries. Level of Evidence Level IV, retrospective case series.

The Benefit of Magnetic Resonance Imaging for Patients With Posttraumatic Radial Wrist Tenderness

To describe fractures revealed by magnetic resonance imaging (MRI) in a series of skeletally mature patients with radial wrist pain after an acute injury and clinically suspected to have a scaphoid fracture. Additionally, we attempted to assess the diagnostic value of radiographs and computed tomography (CT) in patients with scaphoid and other carpal fractures verified by MRI. We conducted the study prospectively over a 3-year period on skeletally mature patients presenting at our emergency department with tenderness on the radial side of the wrist after an injury. A total of 300 wrists in 296 patients underwent clinical and radiographic examination. We performed low-field, 0.23-T MRI of all injured wrists within 3 working days from inclusion in the study. If the radiographs or MRI revealed a scaphoid fracture, we immediately carried out a supplementary 16-slice CT scan of the wrist. We calculated the sensitivity and specificity of radiographs and CT for the diagnosis of scaphoid fractures using MRI as the reference standard. We diagnosed a total of 224 fractures in 196 wrists using MRI; 42% were scaphoid fractures, 15% were distal radius fractures, 6% were triquetrum fractures, and 5% were capitate fractures. The most commonly found fracture combinations were that of the scaphoid and distal radius, followed by scaphoid and capitate fracture. The sensitivity of radiographs for visualization of scaphoid fractures was 70% and the specificity was 98%. Radiographic sensitivity for other fractures was less than 60%. The sensitivity of CT for visualization of scaphoid fractures was 95%, and between 75% and 100% for other fractures. Low-field MRI showed a high incidence of fractures in patients with posttraumatic radial wrist tenderness and demonstrated more fractures than radiographs and CT. A scaphoid fracture was by far the most common injury. However, it is not clear whether diagnosis of subtle injuries only demonstrated on MRI improves outcomes. Diagnostic I.

Fractures of the Scaphoid, Capitate and Triquetrum in a Child: A Case Report

Carpal fractures in children are rare, especially with a combination of scaphoid, capitate, and triquetrum fractures. We report one such case in a 10-year-old boy who was successfully treated with Kirschner wires.

Dorsal Triquetrum Fracture

The patient was a 39-year-old man who self-referred to a physical therapist with a chief complaint of right wrist pain after falling backward onto an outstretched right hand the previous day. Based on the suspicion of a fracture, right wrist radiographs (posterior-to-anterior, lateral, and oblique views) were completed, which revealed a comminuted dorsal triquetrum fracture. The patient was referred to an orthopaedic surgeon who recommended nonoperative management.

Combined Lunate and Triquetrum Fracture: A Case Report

Combined Lunate and Triquetrum Fracture: A Case Report

MDCT and Radiography of Wrist Fractures: Radiographic Sensitivity and Fracture Patterns

The purpose of our study was to determine which wrist fractures are not prospectively diagnosed at radiography using CT as a gold standard and to identify specific fracture patterns. Through a search of radiology records from January 1 to December 31, 2005, 103 consecutive patients were identified as having radiographic and CT examinations of the wrist. After excluding incomplete or nondiagnostic examinations and those with a greater than 6-week interval between imaging studies, the final study group consisted of 61 wrist examinations in 60 patients. Two musculoskeletal radiologists and one emergency radiologist blindly reviewed CT examinations, and each bone (scaphoid, lunate, triquetrum, pisiform, trapezium, trapezoid, capitate, hamate, metacarpals, distal radius, distal ulna) was categorized as normal or fractured, with agreement reached by consensus. Each prospective radiographic report was categorized as either normal or fracture/equivocal for each osseous structure. Results were compared using the chi-square and Fisher's exact tests. In the proximal carpal row, lunate and triquetrum fractures were often radiographically occult (0% and 20%, respectively, detected at radiography); whereas in the distal carpal row, trapezoid, capitate, and hamate fractures were often occult (0%, 0%, and 40% detected at radiography, respectively). Hamate fractures were significantly associated with metacarpal fractures, and distal radius fractures were associated with scaphoid and ulna fractures. Thirty percent of wrist fractures were not prospectively diagnosed on radiography, suggesting that CT should be considered after a negative radiographic finding if clinically warranted. The location of a dorsal scaphoid avulsion fracture emphasizes the need for specific radiographic views or cross-sectional imaging for diagnosis.

Value of bone scintigraphy in patients with carpal trauma

We planned this study to evaluate the role of bone scintigraphy in patients with suspected carpal fracture and normal or suspicious radiographs following carpal injury. Three-phase bone scintigraphy using Tc-99m-MDP was performed on 32 patients with negative radiographs but clinically suspected fracture at two weeks after the trauma. Focally increased radiopharmaceutical uptake was interpreted as a fracture. The final diagnosis was established with clinical follow-up. Twelve (38%) patients had a normal scan excluding fracture. Twelve patients had a single fracture. Multifocal fracture was present in 8 (25%) patients. Eight patients showed scaphoid fractures; of these three showed single scaphoid fracture, and the other five patients revealed accompanying fractures. Distal radius fractures and carpal bone fractures other than scaphoid were both observed in 12 patients. These were eleven fractures of distal radius; three fractures of pisiform; two fractures of hamate; and single fractures of lunate, trapezium and triquetrum. In one patient there was fracture of a first metacarpal bone. In patients with suspected carpal bone fracture and normal or suspicious radiographs, bone scintigraphy can be used as a reliable method to confirm or exclude the presence of a scaphoid fracture and to detect clinically unsuspected fractures of distal radius and other carpal bones.

Non-union fractures of the scaphoid and carpal bones in children: surgical treatment

Carpal bone fractures in children are rare. This study reports a series of 16 cases: 12 fractures of the scaphoid (11 non-union), two of the trapezium, one (non-union) of the hamatum, and one of the triquetrum. Only three of these fractures (triquetrum, trapezium and hamatum) were seen at an early stage. The non-union cases involving the scaphoid and hamatum were treated by bone graft. The scaphoid fracture seen early and the triquetrum fracture were treated orthopaedically. One trapezium fracture was treated by osteosynthesis with wires, and the other (seen at the defective callus stage) was not treated because of a total absence of symptomatology. All fractures or non-union cases consolidated. After a minimum follow-up of 1 year, all patients except one have regained strength and mobility comparable to that of the contralateral limb, with a near total absence of pain. Only the patient with an articular fracture of the trapezium has lost 30% of strength compared with the uninjured limb.

Carpal Fractures in Children

Carpal fractures in children are uncommon injuries, with the scaphoid being fractured most frequently. Thirty-three children with scaphoid fractures and one child each with fractures of triquetrum, trapezoid, hamate, and capitate were retrospectively reviewed. The mean age was 13 years, 4 months. The mechanism of injury was of low energy in most cases, with > 80% of injuries involving a fall. Localizing tenderness was present in 100% of cases. Of fractures, 97.3% were evident on the initial radiographs. One patient required a bone scan to confirm the diagnosis. All but one scaphoid fracture went on to union with conservative treatment in a long-arm thumb spica cast or short-arm thumb spica cast at a mean of 7.1 weeks. All other carpal fractures healed at a mean of 4.5 weeks. The one scaphoid nonunion was attributed to noncompliance by the patient.