Image Quiz
Posttraumatic Wrist Pain1 (continued)
Answer: Nonunion of triquetral body fracture.
Fig. 2-A |
Fig. 2-B |
Figs. 2-A and 2-B Sagittal reconstruction (Fig. 2-A) and axial (Fig. 2-B) computerized tomographic images, made six months after the injury, revealing the presence of a triquetral osseous nonunion. The white arrow in the axial image points to the nonunion site..
For larger view, click on image |
Discussion
Various mechanisms of injury to the triquetrum have been described, including rotational or twisting injuries, shearing by impingement of the hamate on the posteroradial projection of the triquetrum, impaction by the ulnar styloid, falls with the wrist in extension and ulnar deviation, and direct blows to the dorsum of the triquetrum.
Isolated triquetral body fractures are uncommon, and nonunion of these fractures is extremely rare. We identified only one other case of a triquetral body nonunion in the literature. In that case, the patient was treated with immobilization. Unfortunately, the nonunion never healed, and the patient remained symptomatic at the time of the final follow-up. Our patient initially was treated with immobilization but then underwent surgical repair with compression-screw fixation and bone-grafting to achieve union, similar to the way in which other carpal bone fracture nonunions are treated. Osseous union was achieved three months after the injury, resulting in resolution of symptoms and complete functional recovery. To our knowledge, the present report is the first to describe the surgical treatment of a triquetral body fracture nonunion.
Reference
1. Abboud JA, Beredjiklian PK, Bozentka DJ. Nonunion of a triquetral body fracture: a case report. J Bone Joint Surg Am. 2003;85:2441-4.
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