LETTER


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



V. Athanasiou, A. Panagopoulos*, ID. Iliopoulos, I. Vrahnis, G. Diamantakis, P. Kraniotis, M. Tyllianakis
Department of Hand Surgery, Orthopaedic Clinic of Patras University Hospital, Patras, Greece


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© 2018 Athanasiou et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: (https://creativecommons.org/licenses/by/4.0/legalcode). This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Hand Surgery, Orthopaedic Clinic of Patras University Hospital, Andreas Panagopoulos, Papanikolaou str 1, 26504, Rio, Patras, Greece; Tel: +306944363624; E-mail: andpan21@gmail.com


Abstract

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.

Keywords: Triquetrum fracture, Intra-articular fracture, Pisotriquetral joint, pPisiform subluxation, FCU subluxation, Dorsal carpal ligament tears.