The hand is composed of many different bones, muscles, and ligaments that allow for a large amount of movement and dexterity. There are 3 major types of bones in the hand itself, including:
Phalanges
The phalanges of the hand are the group of small bones that comprise the bony core of the digits of the hand. Even though the phalanges are small in size, they are classified as long bones because of their structural characteristics; each phalanx consists of a shaft, distal head, and a proximal base.
Metacarpal bones
A metacarpus is a group of five bones of the hand between the phalanges and the carpus. Even though the metacarpal bones are small, they are classified as long bones since they have structural characteristics of long bones; each metacarpal bone consists of a shaft, distal head, and a wide proximal base.
Carpal bones
The carpus is the anatomical term for the wrist which connects the radius and ulna of the forearm with the metacarpal bones of the hand. It is comprised of eight individual carpal bones that are seated in two neat rows of four. The proximal row of carpal bones, as seen in a lateral to medial direction on the palmar surface, include the scaphoid bone, lunate bone, triquetral bone, and pisiform bone.
The triquetrum is known to be a part of the wrist known as the triquetral bone. This specific type of bone is part of the carpus, a group of eight wrist bones. The triquetrum and other bones in the carpus are located between the two major bones in the forearm, the radius, and ulna. Triquetral fractures most commonly occur after a fall onto an outstretched hand, especially if your wrist is bent back and tilted (wrist extension & ulna deviation). A direct impact from a blunt, hard object on the back of the wrist could also cause this injury.
Triquetral fractures may occur in isolation, with no other associated injuries. However, they are often more complicated and occur alongside other carpal fractures and dislocations. If you have a broken wrist then you may also have damage to muscles, tendons, and ligaments as well. Normally, these fractures are immobilized with a recovery estimation of 4-5 weeks upon treatment.
Causes & Symptoms of a Triquetral Fracture
A triquetral fracture can be caused the same way as for any other types of carpal fractures, including:
Traumatic events
A triquetral fracture may be caused by a traumatic pressure or force on the wrist like while falling down on an outstretched hand with the little finger side of the hand downwards, especially with the wrist in an extended position. Furthermore, if the force is beyond the tolerance power of the bone then this may result in cracking of the triquetral bone resulting in a rupture.
Vehicle / motorbike accidents
Vehicle collisions can cause the carpal bones to break, sometimes into many pieces, and often require surgical repair.
Sports activities
If you take part in sports such as skiing, soccer, American football, or rugby, you may be at a higher risk of breaking the triquetrum bone.
The symptoms of a triquetral fracture can vary from person to person. In some patients, the fracture may cause little to no pain, while in others, it may cause an immense amount of pain. Therefore, the following symptoms below are linked to triquetral fractures:
Swelling
There may be some visible swelling on the fractured area. Swelling is one of the first symptoms that may occur after a fracture.
Pain
Pain is usually the first symptom to occur. Some people may feel little to no pain while others may feel an extreme amount of wrist pain. The pain may vary, but most people can experience pain with a fracture. This pain will be located on the smallest finger side of your wrist.
Tenderness
Tenderness when touched or untouched will be present.
Limited mobility
You will have trouble when attempting to grab on a lot of things with your injured wrist, with a limited amount of motion.
Who gets a Triquetral Fracture?
Triquetral fractures aren’t always the result of falling onto an outstretched hand. Therefore, other risk factors may play a role in developing the condition, such as:
Gender
Women are more prone to experiencing a fractured triquetrum bone once they reach 50 years old, thus doubling the risk every 10 years. For men, the onset of age-related is much later, around the age of 80.
Occupational laborers
Working in occupations that require you to climb and/or operate machinery can put you at an increased risk of breaking your carpal bones.
Age
For children, there is a period during which bones have grown longer due to growth spurts, however, the bone mineral density has not yet caught up. These may leave the newly-grown bones more vulnerable to fractures. For older adults, they are at greater risk of a fractured wrist as hormone levels shift and bone mineral density begins to decrease (degeneration), which is the same mechanism that leads to osteoporosis.
Sports
As mentioned earlier, athletes who participate in sports that involve potential falls, such as skiing, soccer, American football, or rugby, are also at a higher risk of a triquetral fracture.
How Does a Triquetral Fracture Affect You? How Serious is it?
Surgical procedure is done in instances where the triquetrum bone has completely ruptured to a degree where it cannot be rectified by conservative treatment. This special technique is known as open reduction.
Surgery for a triquetral fracture is quite difficult as the triquetral bone is small and often requires pins and screws to be accurately stabilized. Complications with or without surgery are rare, however, they include the following:
- Ongoing stiffness – Stiffness, pain, or aching in the affected wrist normally relieves itself eventually after you have been treated with a cast or after surgery. But you may have permanent stiffness or pain if you leave your fractured triquetrum bone untreated.
- Osteoarthritis – Fractures that extend into a joint can cause arthritis years later.
- Nerve or blood vessel damage – Trauma to the wrist can injure adjacent nerves and blood vessels. It is required to seek immediate attention if you have numbness or circulation problems.
Recommended Treatment & Rehabilitation for a Triquetral Fracture
During a diagnosis of a triquetral fracture, a physician will perform a three-step diagnostic process, which involves a full medical history, physical examination, and additional imaging tests. Firstly, your physician will ask you for a detailed description of your current symptoms, how they began to take effect, and what triggered them.
Next, he or she will examine your wrist and forearm for any dislocation or discoloration. Your doctor may also manipulate your affected wrist or ask you to perform certain hand or wrist movements. Further imaging tests may be ordered to increase the chance of getting a clearer diagnosis for your fractured triquetrum bone. Some of these include:
- Computed Tomography (CT) scan – CT scans can uncover wrist fractures that X-rays usually miss. Injuries to soft tissues and blood vessels can be seen on CT scans.
- Magnetic Resonance Imaging (MRI) – Using radio waves and a powerful magnet to produce detailed images of bone and soft tissues, MRIs are much more sensitive than X-rays and can identify very small fractures and ligament injuries.
After a diagnosis has been successfully done, physiotherapy may be further advised. A physiotherapist will work with you following a triquetral fracture to help regain regular wrist motion, strength, and function, and will provide education and training to help you prevent any future injuries. Therefore, while your bone heals, your arm will be equipped in a cast or sling to keep it still and promote healing.
During that time, it is important to ensure that the arm does not get too stiff, weak, or swollen. Depending on the amount of activity that is allowed for your type of fracture, your physiotherapist will prescribe gentle exercises to keep your shoulder, elbow, and fingers moving while you are in the cast or sling.
After your cast is removed, your wrist will most likely feel very stiff, and your arm will feel weaker. Therefore, your therapist will examine your wrist, and design a treatment plan specific to your condition and goals to improve its function and restore strength to your arm. Your treatment will include:
Pain management
Your physiotherapist will help you identify and avoid painful movements and show you how to correct abnormal postures to reduce stress on the wrist. He or she will recommend resting the wrist short-term and applying ice to the area to help alleviate the pain. Your therapist may also apply a wrist brace to restrict wrist movement.
Manual therapy
Your physiotherapist may use manual techniques, such as gentle joint movements, soft-tissue massage, and wrist stretches to get your wrist moving properly.
Range-of-motion exercises
You will learn exercises and stretches to reduce stiffness and help your wrist, hand, and forearm begin to move properly.
Strengthening exercises
Your physiotherapist will determine which strengthening exercises are perfect for you, depending on your specific areas of weakness. Therefore, your therapist will design an individualized home-exercise program to meet your needs and goals.
Patient education
Depending on the activities you plan on continuing, your physiotherapist will teach you different ways to perform actions, while protecting your wrist and hand. For instance, keeping the wrist in a neutral position to reduce excessive force while performing repetitive tasks, and taking frequent breaks are ways to decrease your chances of reinjury.
Below are some examples of exercises for you to try. The exercises may be recommended to reduce symptoms linked to a triquetral fracture:
Wrist flexion and extension
Place your forearm on a table, with your hand and affected wrist extended beyond the table, palm down. Next, bend your wrist to move your hand upward and allow your hand to close into a fist, then lower your hand and allow your fingers to relax. Hold each position for 6 seconds, then repeat 8-12 times a day.
Wrist radial and ulnar deviation
Hold your affected hand out in front of you, palm down. Slowly bend your wrist as far as you can from side to side. Hold each position for 6 seconds, then repeat 8-12 times a day.
Hand flips
While seated, place your forearm and affected wrist on your thigh, palm down. Flip your hand over so the back of your hand rests on your thigh and your palm is up. Alternate between palm up and palm down while keeping your forearm on your thigh. Repeat this method 8-12 times a day.
Wrist extensor stretch
Extend your arm with the affected wrist in front of you and point your fingers toward the floor. With your other hand, gently bend your wrist farther until you feel a mild to moderate stretch in your forearm. Hold the stretch for at least 15-30 seconds, then repeat 2-4 times a day.
Wrist flexor stretch
Extend the arm with the affected wrist in front of you with your palm facing away from your body. Then, bend back your wrist, pointing your hand up toward the ceiling. With your other hand, gently bend your wrist farther until you feel a mild to moderate stretch in your forearm. Hold the stretch for at least 15-30 seconds. Repeat this exercise 2-4 times a day.
Alternative & Homeopathic Treatment for a Triquetral Fracture
If you experience mild symptoms of a triquetral fracture, you may be able to ease your symptoms with a set of homeopathic treatments. Here are a few treatments for a fractured triquetral bone:
Take breaks from repetitive activities
Whether you are typing, playing guitar, or using a hand drill, try setting a timer beforehand for 15 minutes. When it goes off, stop what you’re doing and wiggle your fingers. Stretch your hands and move your wrists to help improve blood flow to these areas.
Rest
If you ever find yourself straining or forcing tasks such as writing, typing, or using a cash register, relax your grip or reduce the force you are using. Try using a soft-grip pen or tapping keys more lightly.
Stay warm
Keeping your wrist and hands warm can help with pain and stiffness. Consider wearing a fingerless glove or keeping hand warmers nearby.
Non-steroidal anti-inflammatory medications (NSAIDs)
Medications such as ibuprofen, can help reduce further swelling and inflammation.