Trapezial Fractures and Associated Fractures of the Ulnar Carpus: A Ring-Bone Model.

BACKGROUND: Fractures of the trapezium are rare; however, the incidence may be under-reported in the literature. The incidence of ulnar-sided carpal body fractures as a concomitant injury has not been reported. Our study aimed to evaluate the incidence of trapezium fractures in conjunction with ulnar-sided carpal body fractures. METHODS: Over a five-year period, our electronic records were queried and charts reporting carpal bone fractures were reviewed. All cases of trapezium fracture were evaluated further and presented. RESULTS: Eight trapezial fractures were identified, representing 8% of all carpal fractures and 26% of all nonscaphoid carpal fractures. Of the eight trapezium fractures identified, five (62.5%) were associated with Bennett fracture and four (50%) were associated with ulnar-sided carpal fractures. CONCLUSION: Our study demonstrates a higher incidence of trapezial fractures than previously reported. Previously unreported concomitant ulnar-sided carpal body fractures are reported at a frequency nearly equal to that of concomitant Bennett fractures in our series. We propose a mechanism of injury where the carpal canal and overlying transverse carpal ligament function as a ring-bone construct similar to the pelvis. When a trapezium fracture is identified, we recommend additional evaluation for ulnar-sided injuries of the carpus.

20-year-old male college basketball prospect • wrist pain after falling on wrist • normal ROM • pain with active/passive wrist extension • Dx?

Right wrist pain 4 days after falling on wrist while playing basketball. Normal range of motion of wrist and hand. Pain with active and passive wrist extension.

[Fracture of os capitatum and os triquetrum in a child].

This is a case report of a seven-year-old boy with fractures of the capitate and triquetral bone. An X-ray revealed fractures of the capitate and triquetral bone, and a CT scan showed non-dislocated fractures suitable for conservative treatment. The patient was treated with a shin cast for four weeks and had full recovery. Fractures of both the capitate and triquetral bone in children under the age of ten have not previously been reported. Fractures of the carpal bones should be suspected and examined in children with relevant trauma and symptoms.

Association of lunate morphology, sex, and lunotriquetral interosseous ligament injury with radiologic measurement of the capitate-triquetrum joint.

OBJECTIVE: Radiologic presentation of carpal instability at the radial side of the carpus, e.g. scapholunate diastasis following scapholunate interosseous ligament injury, has been studied extensively. By comparison, presentation at the ulnar-sided carpus has not. The purpose of this study was to assess the effects of lunate morphology, sex, and lunotriquetral interosseous ligament (LTIL) status on the radiologic measurement of the capitate-triquetrum joint (C-T distance). Further, we sought to evaluate the diagnostic accuracy of C-T distance for assessing LTIL injuries. MATERIALS AND METHODS: We retrospectively identified 223 wrists with wrist radiographs and MR arthrograms with contrast injection. Data collected included sex, lunate morphology and LTIL status from MR arthrography, and C-T distance from radiography. The effects of lunate morphology, sex, and LTIL injury status on C-T distance were evaluated using generalized linear models. Diagnostic performance of C-T distance was assessed by the area under receiver-operator characteristic curve (AUROC). RESULTS AND CONCLUSION: Lunate morphology, sex, and LTIL injury status all had significant effects on C-T distance; wrists with type II lunates, men, and wrists with LTIL injuries had greater C-T distances than wrists with type I lunates, women, and wrists without LTIL injuries, respectively (p < 0.01). The diagnostic value of the C-T distance for identifying patients with full-thickness LTIL tears was sufficient for women with type I (AUROC = 0.67) and type II lunates (0.60) and good for men with type I (0.72) and type II lunates (0.77). The demonstrated influence of LTIL status on C-T distance supports the use of C-T distance as a tool in assessing for full-thickness LTIL tears.

Fractura bilateral simultánea del piramidal / Simultaneous bilateral triquetrum bone fracture

No disponible

Management of lunotriquetral instability: a review of the literature.

UNLABELLED: Lunotriquetral ligament injury is a relatively common cause of ulnar-sided wrist pain. Injury ranges from partial stable ligament tears to extensive perilunate instability. Clinical decision-making largely depends on the chronicity, instability and cause of the ligament injury. Conservative treatment is generally regarded as first choice of treatment of mild lunotriquetral instability; however, outcome studies on conservative treatment are lacking. Temporary arthroscopic pinning and/or debridement are minimally invasive procedures of preference. In the case of more dissociative injury, surgical interventions may be performed. The literature suggests that soft tissue reconstruction is an effective procedure in this group. Arthrodesis of the lunotriquetral joint is associated with high rates of non-union (up to 57%) and the indications for surgery should therefore be very clear. Methodological issues make it hard to draw firm conclusions from the data. Studies on the effectiveness of conservative management and prospective comparative studies will further improve clinical decision-making in lunotriquetral instability. LEVEL OF EVIDENCE: N/A.

Lesión traumática de la porción proximal del ligamento lunopiramidal como causa de dolor sin inestabilidad articular. Presentación de 2 casos y revisión bibliográfica / Posttraumatic lunotriquetral partial ligament injury as the cause of wrist pain without instability. Two case reports and biblioigraphic review

El dolor postraumático de muñeca continúa siendo hoy un complejo desafío diagnóstico como así también un serio problema clínico en la población joven y laboralmente activa, presentando un alto porcentaje de estos pacientes lesiones ligamentarias inadvertidas de la muñeca. Presentamos 2 casos de lesión parcial del ligamento lunopiramidal postraumática como causa de dolor de muñeca sin inestabilidad, diagnosticados y tratados por vía artroscópica. La remoción artroscópica del colgajo suelto lesionado de la porción membranosa del ligamento lunopiramidal resultó en un alivio de los síntomas. El diagnóstico de esta lesión requiere de un alto índice de sospecha. La RMN sin contraste es de baja sensibilidad para el diagnóstico de las lesiones parciales de los ligamentos interóseos proximales de la muñeca.

Post-traumatic wrist pain remains today a complex diagnostic challenge as well as a serious clinical problem in the young working population, presenting a high percentage of these patients unnoticed wrist ligament injuries. We report 2 cases of posttraumatic lunotriquetral partial ligament injury as the cause of wrist pain without instability, diagnosed and treated arthroscopically. Arthroscopic removal of loose flap injured portion of lunotriquetral membranous ligament resulted in relief of symptoms. The diagnosis of this injury requires a high index of suspicion. MRI without contrast presents low sensitivity for the diagnosis of partial lesions of the proximal interosseous ligaments of the wrist.

Diagnosis and Treatment of Acute Lunotriquetral Ligament Injuries.

Isolated acute lunotriquetral (LT) injuries are an uncommon diagnosis in hand surgery. Diagnosis is aided by a high index of suspicion when pain is localized over the LT joint. Standard radiographs show typically normal findings, leading to advanced diagnostic investigations, including MRI and wrist arthroscopy. Standard treatment options for acute LT injuries include immobilization, arthroscopy, and direct open LT repair.

Diagnosis and Treatment of Chronic Lunotriquetral Ligament Injuries.

Chronic lunotriquetral (LT) injuries are less common than scapholunate ligament injuries and difficult to diagnose. They may be associated with positive ulnar variance. Clinical diagnostic tests elicit pain at the LT interval. Although radiographs are typically normal, MRI and wrist arthroscopy can help confirm the diagnosis. When conservative treatments fail, surgical options include LT ligament reconstruction, LT arthrodesis, and ulnar-shortening osteotomy (in patients with positive ulnar variance).

A rare coronal fracture of the medial carpal column: Case report.

Carpal coronal fractures are rare. We report the case of a 15 year-old male who fell from a balcony and suffered a displaced coronal fracture of the capitate, hamate and triquetrum. The diagnosis, which was initially made based on the X-rays, was confirmed by CT scan. Open reduction and internal fixation using Herbert screws was performed. To the best of our knowledge, this is the first published case of a coronal fracture of these three bones. The patient returned to normal activities after six months.

Evaluation for fracture patterns around the wrist on three-dimensional extremity computed tomography, especially focused on the triquetrum.

INTRODUCTION: To describe fracture patterns of triquetrum and analyse them according to fracture classifications, anatomy of intrinsic carpal ligaments and comparison with other wrist fractures. METHODS: We retrospectively reviewed 297 three-dimensional extremity computed tomographies (CTs) on wrist fractures from October 2007 to January 2012. We initially classified the fractures according to the involved bones and analyzed them according to the patterns of triquetrum fractures, associated carpal bone fractures and presence of combined distal radius fractures. We also correlated the fracture patterns with the patient's injury patterns. RESULTS: A total of 297 CTs and 291 patients were included (162 males and 129 females; mean age, 47.8 years). There were a total of 131 carpal bone fractures in 102 patients of 102 CTs. Triquetrum fractures were the most commonly observed cases (36 cases/27.5%). For the triquetrum fractures, the following types were observed: 26 dorsal, five volar, two comminuted fractures are observed in triquetrum. Three other triquetrum fractures show combined forms of other carpal bone fractures. For the combined distal radius fractures, 10 dorsal and two volar fractures were shown. Out of 187 distal radius fractures, 20 showed carpal bone fractures (10.7%). There were no differences in injury patterns according to the fracture patterns. The most common pattern of injury was falling on the outstretched hand, followed by fall from height. CONCLUSION: The dorsum of triquetrum is more frequently fractured than the volar aspect. The number of carpal bone fractures among the patients who have distal radius fractures is higher than usual expectation.

Volarly displaced transscaphoid, translunate, transtriquetrum fracture of the carpus: case report.

A 16-year-old girl sustained a transscaphoid, translunate, transtriquetrum volarly displaced fracture due to shear stress in the coronal plane. Treatment involved open reduction and internal fixation of the fractures followed by immobilization. At 15 months' follow-up, grip strength and motion were diminished compared with the uninjured wrist. Radiographs demonstrated fully healed fractures with narrowing of the cartilage space between the capitate and the lunate.

Carpal fractures.

Carpal fractures are exceedingly rare clinical entities and are often associated with concomitant injuries. In this review, we focus on fractures of the carpus, excluding the scaphoid, and provide an update on the current consensus as to mechanism, diagnosis, management, outcomes, and complications after such injuries.

Cystic avascular necrosis of the triquetrum.

Carpal bones are rarely affected by avascular necrosis (AVN) in the absence of fractures. The lunate is the most frequently affected carpal bone, followed by the scaphoid and the capitate. The triquetrum is rarely affected by AVN. We report a case of multiple cystic changes in the triquetrum in a patient with a history of trauma. He was treated by below elbow Colles plaster cast for 3 months, with no improvement. Cystic changes resulted from irreversible AVN of the triquetrum. This is the first case to be reported in the literature with cystic AVN changes in the triquetrum.