Wrist consists of eight small bones, which are located between the bones of the forearm known as ulna and radius and the bones present in the hand. The triquetral bone is one of these eight small bones situated in the wrist. The shape of a triquetral bone is just like a pyramid. A triquetral bone is fractured less frequently when compared to the fractures of the scaphoid and lunate bones of the same area.
Compression or stress could be placed on the triquetral bone while falling down on an outstretched hand. If the force is traumatic and beyond the tolerance power of the bone then this may result in cracking of the triquetral bone resulting in triquetral fracture. A triquetral bone is occasionally called as a triquetrum. The two main causes of a triquetral fracture are falls and car accidents. This often leads to pain, decreased mobility, and swelling which may affect the functioning of the hand, forearm and wrist.
Triquetral fractures occasionally occur without any associated injury to the surrounding structures, but they often are quite complicated and include injuries to the surrounding structures such as the lunate and other soft tissue injuries.
Causes of Triquetral Fracture
- A triquetral fracture may be caused by a traumatic pressure or force on the wrist like while falling down on an outstretched hand with the little finger side of the hand downwards, especially with the wrist in an extended position.
- A direct trauma from hard object on the backside of the wrist.
- Car accidents.
- A triquetral fracture is mostly common in sports activities like snowboarding or skateboarding, especially in icy atmosphere.
Signs and Symptoms of Triquetral Fracture
- Pain is felt in the wrist after an impact or a fall.
- Pain on the little finger side of the wrist could be experienced.
- Tenderness with palpation of affected region.
- Reduced range of motion of wrist.
- Decreased grip strength.
- Pain while lifting an object with the injured wrist.
Treatment for Triquetral Fracture
In instances where fracture is minute or there is displacement of bone from its normal position, it is treated with manipulation and reduction. This is done via local anesthesia and then casting. Fracture requires about 10 weeks to completely heal. It includes time of immobilization with being in a splint for some time. RICE protocol of affected hand is followed.
Surgery for Triquetral Fracture
Surgical procedure is done in instances where damage is to a degree where it cannot be rectified by conservative treatment. This technique is termed as open reduction. Surgery for triquetral fracture is quite difficult as triquetral bone is quite small and often requires pins and screws to be stabilized.
Procedure is done by making a nick to expose the fracture in order to bring it back to its usual position. Sometimes, pins, plates, etc. are also used.
Surgery involves risk of bleeding, neurovascular injury etc.
Physical Therapy (PT) for Triquetral Fracture
This is essential to facilitate healing and make the wrist function normally. This includes:
- Joint mobilizations.
- Soft tissue massages.
- Ice and heat.
- Improving strength via exercises.
- Activity alterations.
- Returning back to activities.
Exercises for Triquetral Fracture
Stretching and strengthening is done in the recuperating stage for complete range of motion and attaining normal function of wrist.
Stretching Exercises for Triquetral Fracture
Flexion: This is done by bending wrist forward till painless stretch is sensed for 10 seconds. This should be performed in 3 sets of 12.
Extension: This is done by bending wrist backward till painless stretch is sensed for 10 seconds. This should be done in 3 sets of 12.
Side-to-Side: This is done by moving wrist sideways till painless stretch is sensed for about 10 seconds in each direction. This should be done in 3 sets of 12.
Wrist Extension Stretch: This is done by keeping elbow straight and placement of fingers on a flat surface with palms looking down. Now, the body is bent forward and the position is kept for about 20 seconds.
Wrist Flexion Stretch: This is done by keeping elbow straight and placement of fingers on a flat surface with palms looking up. Now, the body is bent forward and the position is kept for about 20 seconds.
Forearm Pronation and Supination: This is done with elbow bent at a right angle. Now the palm is rotated upwards and position held for 10 seconds. The, do it the opposite way fo 10 seconds. This should be done in 2 sets of 10 without increasing symptoms.
Strengthening Exercises for Triquetral Fracture
Wrist Flexion: This is done by grasping a can with palms facing up. Then the wrist is bent upward. Slowly, the weight is decreased. This is done in 3 sets of 12 and the weight of the object is increased slowly.
Wrist Extension: This is done by grasping a can with palms facing down. Then the wrist is bent upward. Slowly, the weight is decreased. This is done in 3 sets of 12 and the weight of the object is increased slowly.
Tennis Ball Squeeze: To do this, a spongy material is taken and squeezed hard without experiencing any pain for about 10 seconds. This is repeated 10 with increasing pain.
Investigations for Triquetral Fracture
A comprehensive examination is carried out for diagnosis of triquetral fracture to include a neurovascular examination to look for damage to nerves. An x-ray is taken to look for the extent of the injury.
Other Tests Are:
- CT scan.