Causes and risk factors
Like any other fracture, injury is the main causative factor for triquetral fracture. Direct and severe blow on the dorsal aspect of the hand and extreme dorsiflexion are the main contributing factors. Road accidents or vehicle injury or fall on wrist can lead to its breakage. Indirect trauma can also lead to triquetral fracture. A severe pressure on the hamate bone can cause great force on the triquetrum leading to its displacement. Microtrauma due to repeated force or trauma is another contributing factor seen.
Clinical presentation:
Pain is a prominent feature seen. Along with this, swelling and bruising are the other complaints. Pain is especially seen at the medial aspect of the wrist. Weak grip and weak pinch is complained by the patient. On examination, point tenderness typically at the triquetral is seen.
Investigations:
Considering the symptoms, a local examination is carried out by the orthopedic doctor. There is often a history of injury. X-ray of the carpal bones is sufficient for diagnosis. If required, a CT scan can be done. Radiological fracture of triquetral is classified into two types – fracture of the body and chip fractures.
Treatment:
Rest, elevation of the arm, and application of ice pack are the essential steps to be implemented. Analgesic or nonsteroidal anti-inflammatory drugs are advised by the orthopedic doctor for relief of the pain. The treatment depends upon the type of fracture. Triquetral chip fracture needs cast application for immobilization for 2-3 weeks while triquetral body fractures requires immobilization for 4-6 weeks. In case of displaced chip or body fracture, surgical intervention is needed. Open reduction and internal fixation is done.
This is followed by exercises which will help to improve the mobility. Short arm cast is applied for immobilization for 6-8 weeks. Usually the conservative method of treatment gives an effective result. As recovery starts, certain physiotherapy exercises are advised under the guidelines of a trained physiotherapist.
Other Modes of treatment:
Certain other modes of treatment can also be helpful in coping up with the symptom. Taking into consideration the symptoms in a holistic way, homoeopathy can offer a good aid for the relief of the symptoms. The Ayurvedic system of medicine which uses herbs and synthetic derivates can also be beneficial in combating the complaints. Certain yoga exercises can also be helpful in strengthening the muscles.
