Avulsion Fractures of the Triquetrum

Why is the triquetrum bone important?

The bones of the wrist are held together by strong ligaments. One of the larger ligaments, called the dorsal radiocarpal ligament, inserts onto the triquetrum bone.

What causes an avulsion fracture of the triquetrum?

This type of fracture is usually caused by a fall onto an outstretched hand. When a sudden, large force is applied to the ligament, the area of bone around the ligament insertion pulls off the back of the triquetrum. This is usually only seen on a side view of the wrist joint on an Xray

Symptoms of an avulsion fracture of the triquetrum

The wrist is usually very sore, particularly over the back of the wrist around the area of the fracture. The wrist also tends to swell up, again mainly over the back of the wrist. The pain and swelling usually make it difficult to move the wrist and hand.

What investigations are performed?

The diagnosis is made on an Xray of the wrist. Rarely, a scan will be recommended if there is a suspicion of a more serious injury.

Treatment for avulsion fracture of the triquetrum

This injury is a stable injury, so it does not need to be put in a plaster, but a splint or bandage may help with pain relief initially.

The usual recommendation is:

• Day 1-2 Elevate your arm where possible to reduce the swelling. A cold pack or ice pack can help with this. Mobilise your hand by intermittently making a fist and straightening the fingers our fully. Try to do this around 10 times every half an hour. Mobilise your shoulder and elbow on the same side by putting them through a full range of movement at least 3 times per day – before meals is a good time to remember to do this.
• Week 1-4 Start to work on wrist movement as soon as possible. This will feel tight and uncomfortable to begin with, but movement will usually get back to around 90% of normal by 4 weeks after the injury. It is safe to use the hand to do things, and the splint should only be used for short periods.
• Week 4 + The wrist should start to feel much better and it is safe to use it normally at this point. Most people report full return of function by 2-3 months after this injury.

Do I need Physiotherapy?

No formal physiotherapy is required following this injury. If mobilisation is slow or the fingers are particularly stiff, then physiotherapy can help with mobilisation.

When is is safe to drive?

The decision on when to return to driving is the responsibility of each individual, based on whether or not you feel it is safe. For most people with this injury, this is around 2-3 weeks. If you are planning to drive whilst using a splint, you should let your insurance company know about this.

When should I return to work?

It is safe to work immediately after this injury if you work in an office. Most manual workers get back to work within 4 weeks of this injury, although some modification of duties may be needed to support this.

What should I do if my wrist is not getting better?

If you feel that your symptoms are not following the pattern we have outlined above, then please contact us and we can arrange for one of our therapists to see you.