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TRIQUETRUM FRACTURES

Introduction

Fracture Nomenclature for Triquetrum Fractures

Hand Surgery Resource’s Diagnostic Guides describe fractures by the anatomical name of the fractured bone and then characterize the fracture by the Acronym:

In addition, anatomically named fractures are often also identified by specific eponyms or other special features.

For the Triquetrum Fracture, the historical and specifically named fractures include:

Triquetrum dislocations and fracture-dislocations

By selecting the name (diagnosis), you will be linked to the introduction section of this Diagnostic Guide dedicated to the selected fracture eponym.

Fractures of the carpal bones account for ~6% of fractures overall and up to 18% of all hand fractures. The vast majority (58-89%) occurs in the scaphoid, while fractures of the other 7 carpals are uncommon and only comprise ~1.1% of all fractures. The triquetrum is the most frequently fractured of these bones—the second most overall—with the reported incidence of triquetrum fractures ranging from 3.5-30% of all carpal fractures. Avulsion fractures of the dorsal ridge of the triquetrum are by far the most common fracture pattern, and these injuries typically occur from a fall on an outstretched hand (FOOSH) with a volarly flexed and radially deviated wrist. Between 20-50% of triquetrum fractures are associated with other wrist injuries, and the distal ulna and scaphoid are the most commonly fractured bones in these cases. Unlike many other carpal fractures, it appears the majority of triquetrum fractures can be treated conservatively with immobilization alone, while surgery is only reserved for severely displaced fractures and other challenging cases.1-5

Definitions

  • A triquetrum fracture is a disruption of the mechanical integrityof the triquetrum.
  • A triquetrum fracture produces a discontinuity in the triquetrum contours that can be complete or incomplete.
  • A triquetrum fracture is caused by a direct force that exceeds the breaking point of the bone.

Hand Surgery Resource’s Fracture Description and Characterization Acronym

SPORADIC

S – Stability; P – Pattern; O – Open; R – Rotation; A – Angulation; D – Displacement; I – Intra-articular; C – Closed

S - Stability (stable or unstable)

  • Universally accepted definitions of clinical fracture stability is not well defined in the hand surgery literature.6-8
  • Stable: fracture fragment pattern is generally nondisplaced or minimally displaced. It does not require reduction, and the fracture fragment’s alignment is maintained with simple splinting. However, most definitions define a stable fracture as one that will maintain anatomical alignment after a simple closed reduction and splinting. Some authors add that stable fractures remain aligned, even when adjacent joints are put to a partial range of motion (ROM).
  • Unstable: will not remain anatomically or nearly anatomically aligned after a successful closed reduction and simple splinting. Typically unstable triquetrum fractures have significant deformity with comminution, displacement, angulation, and/or shortening.

P - Pattern

  • Triquetrum body: sagittal, oblique, transverse, and/or comminuted
    • Sagittal fractures are typically associated with crush injuries or axial dislocations, while transverse fractures are associated with perilunate injuries and comminuted fractures are from high-energy trauma.2
    • Isolated transverse fractures are very rare and must be differentiated from avulsion fractures.9
  • Triquetrum dorsal ridge (posterior tubercle)
    • Acts as the divide between the dorsal and volar cortices.
  • Triquetrum fractures can be classified by their anatomic location into one of the following 3 types:
    • Type 1: dorsal cortex fractures
  • Most common fracture pattern, especially avulsion fractures of the dorsal ridge, which account for >90% of all triquetrum fractures.10
  • The 2 likely mechanisms of injury are compression fractures—caused by a chisel action of the ulnar styloid process upon the dorsum of the triquetrum, resulting from a FOOSH with the wrist in dorsiflexion and ulnar deviation—and avulsion fractures, which commonly occurs in falls with a volarly flexed wrist and radially deviated hand.3
    • Type 2: body fractures
  • Less common and usually associated with carpal dislocation or other carpal fractures.
  • Typically result from excessive force during a FOOSH with greater dorsiflexion and more ulnar deviation, under the impingement of ulnar styloid process against the triquetrum.3
  • Intra-articular fractures at the distal end of the triquetrum body can also occur from an impaction of a deviated pisiform that produce shear forces on the surface of the triquetrum. These extremely rare injuries are sometimes referred to as osteochondral fractures, but “intra-articular fractures” is preferred.5
    • Type 3: volar cortex fractures
  • Extremely rare fracture pattern.
  • Injury mechanism is considered to be a sheared force of pisiform on the volar, distal, and ulnar surface of triquetrum.3

O - Open

  • Open: a wound connects the external environment to the fracture site. The wound provides a pathway for bacteria to reach and infect the fracture site. As a result, there is always a risk for chronic osteomyelitis. Therefore, open fractures of the triquetrum require antibiotics with surgical irrigation and wound debridement.6,11,12
  • Open fractures of the triquetrum require surgical exploration to determine if articular surfaces are involved. After irrigation and debridement, these wounds are sometimes left open and further treatment is typically delayed until the wound shows no sign of infection.13,14

R - Rotation

  • Triquetrum fracture deformity can be caused by rotation of the distal fragment on the proximal fragment.
  • Degree of malrotation of the fracture fragments can be used to describe the fracture deformity.

A - Angulation (fracture fragments in relationship to one another)

  • Angulation is measured in degrees after identifying the direction of the apex of the angulation.
  • Straight: no angulatory deformity
  • Angulated: bent at the fracture site

D - Displacement (Contour)

  • Displaced: disrupted cortical contours
  • Nondisplaced: fracture line defining one or several fracture fragments; however, the external cortical contours are not significantly disrupted

I - Intra-articular involvement

  • Fractures that enter a joint with one or more of their fracture lines.
  • Triquetrum fractures can have fragment involvement at any of its intercarpal joint articulations.
  • If a fracture line enters a joint but does not displace the articular surface of the joint, then it is unlikely that this fracture will predispose to posttraumatic osteoarthritis. If the articular surface is separated or there is a step-off in the articular surface, then the congruity of the joint will be compromised and the risk of posttraumatic osteoarthritis increases significantly.
  • Intra-articular fractures at the distal end of the triquetrum body have been documented but are extremely rare.5

C - Closed 

  • Closed: no associated wounds; the external environment has no connection to the fracture site or any of the fracture fragments.6-8

Triquetrum fractures: named fractures, fractures with eponyms and other special fractures

Triquetrum dislocations and fracture-dislocations

  • Although fractures of the triquetrum are fairly common, dislocations are extremely rare due to the very strong ligamentous support between its surfaces and the surrounding carpal bones.15
  • Dorsal triquetral dislocations are typically associated with other hand injuries, while volar dislocations are more likely to be isolated injuries.15
  • Possible mechanisms of injury include wrist flexion with ulnar deviation and supination, hyperextension, and a direct blow to the hand.15,16
  • Triquetrum dislocations can also occur in the sequence of a trans-scaphoid perilunate dislocation, in which the link between the lunate and triquetrum is broken.17

Imaging

  • Routine radiographs
    • Triquetrum dislocations are often missed on the initial diagnosis when evaluated solely with routine radiographic views, as the bone is difficult to visualize: the pisiform obscures the triquetrum on the posteroanterior (PA) view and the scaphoid does so on the lateral view.
    • The oblique view is considered most effective for visualizing triquetral dislocations.18
  • Some authors recommend a digital volume tomography or CT scan if a fracture is suspected or there is any sign of carpal misalignment on plain radiographs.15
  • Delays in diagnosis and treatment may lead to irreversible damage to bone and cartilage, and surgical intervention may become necessary, which is why high clinical suspicion is needed when evaluating these wrist injuries.15

Treatment

  • Closed reduction and percutaneous pinning (CRPP)
    • Often not feasible for acute dislocations, but if it is achieved, K-wires should be used to facilitate healing of the lunotriquetral ligament and prevent redislocation.15
  • Open reduction and fixation (ORIF)
    • The preferred treatment for most triquetral dislocations.15
    • Fixation may be achieved using either K-wires or Herbert bone screws, and a volar approach appears to be more suitable for volar dislocations.15,18
    • When applicable, direct repair of torn ligaments should also be performed.15
  • Triquetrum excision
    • May be required in some extreme cases.16

Complications

  • Infection 
  • Carpal instability

Outcomes

  • In general, when triquetral dislocations are diagnosed and treated promptly, good functional outcomes have been reported. Studies have shown that in these cases, most patients experienced little or no pain and only slightly restricted wrist ROM and grip strength at follow-up.15
  • Other studies have reported cases successfully treated with CRPP, ORIF, and triquetrum excision.16

Related Anatomy

  • The triquetrum is a roughly pyramidal-shaped bone located on the medial side of the proximal carpal row that consists of a body and a transverse, dorsal ridge—or posterior tubercle—which divides the volar and dorsal cortices. It articulates distally with the hamate, volarly with the pisiform, radially with the lunate, and proximally with the triangular fibrocartilage complex (TFCC), and does not actually attach to the ulna.
    • Along with the scaphoid and lunate, the triquetrum also forms the distal articular surface of the radiocarpal joint.5,19
    • Despite being the second most common carpal fracture, the triquetrum is well protected proximally by the TFCC and distally by the hamate.20
  • Ligamentous attachments of the triquetrum include the volar scaphotriquetral, volar radiolunatotriquetral, ulnotriquetral, lunotriquetral, and ulnar collateral ligaments. The volar radiolunatotriquetral ligament, which originates from the ulnar side of the radioscaphocapitate ligament and inserts into the lunate and triquetrum, is one of the strongest of all carpal ligaments.3,5
  • The triquetrum does not have any tendinous attachments. 

Incidence and Related injuries/conditions

  • Fractures of the carpal bones have been found to account for 8-18% of all hand fractures21,22and ~6% of fractures overall.23
  • Fractures of the proximal carpals are more common than the distal carpals, and the most commonly fractured carpal bone is the scaphoid, which represents 58-89% of all carpal fractures.21,22,24,25
  • Fractures of the other 7 carpals are very rare and only account for ~1.1% of all fractures. The triquetrum ranks highest of these bones, while fractures of the remaining carpals are even less common and vary in incidence.10,26,27
    • According to the literature, the triquetrum is the second most frequently fractured carpal bone, with a reported incidence ranging from as low as 3.5%10to as high as 30%28of all carpal fractures. 
  • Approximately 12-25% of all triquetrum fractures are associated with perilunate fracture-dislocations.29
  • In one series, the incidence of triquetrum fractures (27.4%) was actually found to be higher than that of scaphoid fractures (25.1%), but this may have been due to selection bias.3
  • Triquetrum fractures have been reported as radiographically occult in up to 80% of cases and are associated with other wrist injuries in 20-50% of cases.19
    • When they do occur concomitantly with other fractures, the distal radius—with or without the distal ulna—and scaphoid are most likely to be involved.4
ICD-10 Codes

  • TRIQUETRUM FRACTURE

    Diagnostic Guide Name

    TRIQUETRUM FRACTURE

    ICD 10 Diagnosis, Single Code, Left Code, Right Code and Bilateral Code

    DIAGNOSISSINGLE CODE ONLYLEFTRIGHTBILATERAL (If Available)
    FRACTURE CARPAL BONE - TRIQUETRUM/CUNEIFORM    
    - DISPLACED S62.112_S62.111_ 
    - NONDISPLACED S62.115_S62.114_ 

    Instructions (ICD 10 CM 2020, U.S. Version)

    THE APPROPRIATE SEVENTH CHARACTER IS TO BE ADDED TO EACH CODE FROM CATEGORY S62
     Closed FracturesOpen Type I or II or OtherOpen Type IIIA, IIIB, or IIIC
    Initial EncounterABC
    Subsequent Routine HealingDEF
    Subsequent Delayed HealingGHJ
    Subsequent NonunionKMN
    Subsequent MalunionPQR
    SequelaSSS

    ICD-10 Reference

    Reproduced from the International statistical classification of diseases and related health problems, 10th revision, Fifth edition, 2016. Geneva, World Health Organization, 2016 https://apps.who.int/iris/handle/10665/246208

Clinical Presentation Photos and Related Diagrams
Triquetrum Fracture Diagrams
  • Triquetrum "Avulsion" Fracture (curved arrow)
    Triquetrum "Avulsion" Fracture (curved arrow)
  • Triquetrum Body Fracture (curved arrow) with overlying pisiform outlined by dotted line
    Triquetrum Body Fracture (curved arrow) with overlying pisiform outlined by dotted line
Symptoms
History of trauma
Fracture pain, swelling, deformity, and/or crepitus
Ecchymosis of the ulnar wrist
Impaired wrist range of motion
Typical History

A typical patient is a 27-year-old left-handed woman who occasionally participates in roller derby competitions as a hobby. During a recent match, she was skating around the track at a reasonably fast speed of ~15 MPH when an member of the opposing team came up from behind and hip-checked her on the right side. This caused the woman to fall to the ground, where she landed with both hands outstretched and her left hand taking the brunt of the impact in ulnar deviation and wrist in dorsiflexion. This resulted in a dorsal cortex fracture of the triquetrum in her left hand and led her to seek out medical attention.

Positive Tests, Exams or Signs
Work-up Options
Images (X-Ray, MRI, etc.)
Triquetral Fracture Imaging
  • Note the small displaced triquetral "avulsion" fracture (arrow)
    Note the small displaced triquetral "avulsion" fracture (arrow)
  • CT cross sectional images of Triquetral (T) Fracture (arrow) with distal and proximal cuts with Pisiform (P)
    CT cross sectional images of Triquetral (T) Fracture (arrow) with distal and proximal cuts with Pisiform (P)
  • CT reconstruction with triquetral fracture (arrow)
    CT reconstruction with triquetral fracture (arrow)
Treatment Options
Treatment Goals
  • When treating closed triquetrum fractures, the treating surgeon has 4 basic goals:6,12
    1. A triquetrum with a normal appearance. The X-ray may not need to be perfect, but the triquetrum should have no obvious deformity (ie, the triquetrum looks normal!)
    2. Avoid stiffness by maintaining a normal functional ROM (ie, the wrist works!)
    3. The triquetrum is not painful (ie, the triquetrum does not hurt!)
    4. Congruent joint surface with none-to-minimal joint surface irregularities (ie, the joints associated with the triquetrum do not develop early posttraumatic arthritis!)
    5. Fracture care should minimize the risk for infection and osteomyelitis.
Conservative
  • Although treatment recommendations for triquetrum fractures depend on their specific type, it appears that most of these fracture patterns can be managed conservatively.5,30
  • Immobilization with either a splint or cast for 3-6 weeks is indicated for most nondisplaced body fractures, dorsal avulsion fractures, and intra-articular body fractures without pisiform dislocation.5,30,31
    • Either a short-arm cast or splint may be used for immobilization.4,5
  • Immobilization should be followed by a progressive return to ROM and wrist strengthening exercises, with pain typically beginning to subside within 4-8 weeks.2
  • Referral to a hand surgeon is recommended for large avulsion fractures, body fractures with >1 mm displacement, nonunion, malalignment of carpal bones, or any fracture accompanied by intercarpal ligament instability.20
Operative
  • Surgical treatment of triquetrum fractures must always be an individualized therapeutic decision. However, surgical triquetrum fracture care is most frequently recommended when:
    1. Closed reduction fails or the simple splint or cast immobilization does not maintain the reduction. For these irreducible or unstable fractures, operative treatment is recommended to achieve the 4 treatment goals of fracture care.
    2. There is a significantly displaced triquetrum fracture fragment involving one of its associated joints. Surgical fracture care may be required in these cases.
    3. Open triquetrum fractures require surgical care in the form of irrigation and debridement to prevent chronic infection.
  • ORIF
    • Typically needed for fractures with marked displacement, in rare cases of nonunion, and when conservative treatment fails and symptoms persist.2,5,9
    • A compression screw or K-wire may be used for fixation.2
  • Surgical excision/resection
    • Utilized by some surgeons for some dorsal avulsion fractures that remain symptomatic for a long period and stubborn TFCC injuries.5,31
  • Bone grafting
    • May be used for some transverse triquetrum fractures.9
  • Surgery is rarely indicated for acute dorsal avulsion fractures.32
Hand Therapy
  • The care and precautions related to immobilization devices for the triquetrum fracture must be carefully reviewed with the patient. Patients should be educated regarding care and precautions. Patients should know that pain, especially increasing pain, numbness, tingling, skin irritation, splint loosening, or excessive splint tightness are red flags and should be reported to the surgeon or his team.
  • Pain should be managed with properly fitting splints, reassurance, elevation, ice in the initial post-fracture period, and mild pain medications. Patients should be encouraged to discontinue pain medication as soon as possible. Opioid use should be kept to a minimum.
  • If an infection does occur, management should focus on eradicating sepsis with thorough debridement, appropriate antibiotics (eg, cephalosporin, penicillin), and fracture stabilization, followed by obtaining fracture union and regaining a functional extremity.13
  • Patients should be instructed to carefully exercise all joints in the injured hand, wrist, and arm that do not require immobilization. Patients usually can exercise on their own; however, signs of generalized hand or wrist stiffness are indications for referral to hand therapy (PT or OT).
Complications
  • Avascular necrosis is a possible complication, but the risk for it is very low due to the rich vascular supply of the triquetrum.4,30
  • Other possible complications include nonunion, persistent ligamentous instability, and posttraumatic osteoarthritis at the pisotriquetral joint.2
    • Both nonunion and pisotriquetral osteoarthritis can be managed with surgical excision of the pisiform if necessary.54
Outcomes
  • In one study, 65 patients with triquetrum fractures were treated conservatively using splint immobilization for 3-8 weeks.
    • At a follow-up after a median period of 46.8 months, outcomes were predominantly positive, as 83% of fractures united—including all that involved the main body—and there was no indication for surgery or posttraumatic instability.27
Key Educational Points
  • Triquetral avulsion fractures are often associated with prolonged pain complaints that seem to be up of portion to size of the typical small fracture fragment. Despite this, the pain frequently resolves with casting or bracing alone.
  • Underlying pathological conditions such as bone tumors—like enchondromas—and osteoporosis should be expected in fractures that occur from trivial trauma.
  • The functional needs of each patient must be considered when recommending treatment for triquetrum fractures.
  • Although non-scaphoid carpal bones like the triquetrum have received considerably less attention than the scaphoid, these injuries can still produce morbidity that is disproportionate to their incidence for 2 primary reasons:
    • These fractures may have a subtle clinical and radiographic presentation and are easily overlooked or misdiagnosed, in some cases as wrist sprains. This can lead to suboptimal management and poor long-term outcomes with significant wrist disability.
    • These fractures are often harbingers of significant ligamentous disruption or associated carpal fractures, and failure to recognize a more global injury pattern can result in undertreatment and permanent wrist dysfunction.1
  • Some patients with an isolated triquetrum fracture may only present with mild pain, which is why clinicians must be aware of other subtle signs of this injury in order to avoid a missed diagnosis.31
  • Bilateral triquetrum fractures are extremely rare but may occur when both wrists are involved in a severe fall on the outstretched hand injury.30
  • Even though triquetrum fractures are fairly common, literature regarding optimal treatment protocols is relatively sparse and often obscured by the associated ligamentous injuries of the wrist.5
  • A high level of clinical suspicion should exist since triquetrum fractures are often missed on routine X-rays.30  PA and anteroposterior (AP) views are not very helpful for visualizing triquetrum fractures—especially dorsal cortex avulsion fractures while lateral views may be slightly more effective.4,5,30
  • Special X-ray views
    • An oblique view with 45° pronation is believed to be the best radiographic view for identifying triquetrum fractures, especially dorsal fractures.20,30
  • CT scan
    • Recommended if occult fractures or concomitant ligamentous injuries are suspected.20,30
  • MRI
    • Another advanced imaging option for suspected occult fractures not identified by X-ray.5
References

New and Cited Articles

  1. Shah MA, Viegas SF. Fractures of the carpal bone excluding the scaphoid. J Hand Surg Am 2002; 2(3): 129-140
  2. Suh N, Ek ET, Wolfe SW. Carpal fractures. J Hand Surg Am2014;39(4):785-91. PMID: 24679911
  3. Oh E, Kim, HJ, Hong, S, et al. Evaluation for fracture patterns around the wrist on three-dimensional extremity computed tomography, especially focused on the triquetrum. J Med Imaging Radiat Oncol 2015;59:47-53.PMID: 25492639
  4. Schubert H. Triquetrum fracture. Can Fam Physician2000;46:70-1. PMID: 10660788
  5. Athanasiou V, Panagopoulos A, Iliopoulos ID, et al. Intra-articular Fracture of the Distal part of the Triquetrum within the Pisotriquetral Joint: Case Report and Review of Literature. Open Orthop J2018;12:84-90.PMID: 29619121
  6. Cheah AE, Yao J. Hand Fractures: Indications, the Tried and True and New Innovations.J Hand Surg Am 2016;41:712-22. PMID: 27113910
  7. Nesbitt KS, Failla JM, Les C. Assessment of instability factors in adult distal radius fractures. J Hand Surg Am 2004;29:1128-38.PMID: 15576227
  8. Walenkamp MM, Vos LM, Strackee SD, Goslings JC, Schep NW. The Unstable Distal Radius Fracture-How Do We Define It? A Systematic Review. J Wrist Surg 2015;4:307-16. PMID: 26649263
  9. Sin CH, Leung YF, Ip SP, et al. Non-union of the triquetrum with pseudoarthrosis: a case report. J Orthop Surg (Hong Kong)2012;20(1):105-7. PMID: 22535823
  10. Garcia-Elias M. Dorsal fractures of the triquetrum-avulsion or compression fractures? J Hand Surg Am1987;12(2):266-8. PMID: 3559084
  11. Ketonis C, Dwyer J, Ilyas AM. Timing of Debridement and Infection Rates in Open Fractures of the Hand: A Systematic Review. Hand (N Y) 2017;12:119-26. PMID: 28344521
  12. Meals C, Meals R. Hand fractures: a review of current treatment strategies. J Hand Surg Am 2013;38:1021-31. PMID: 23618458
  13. Day CS. Fractures of the Metacarpals and Phalanges. In: Green DP, ed. Green's Operative Hand Surgery. Seventh ed. Philadelphia: Elsevier; 2016, pp. 231-77.
  14. Weinstein LP, Hanel DP. Metacarpal fractures.J Hand Surg Am 2002; 2(4):168–180.
  15. Braig D, Koulaxouzidis G, Kalash Z, et al. Volar dislocation of the triquetrum - case report and review of literature. J Hand Microsurg2014;6(2):87-91. PMID: 25414557
  16. Inoue G. Dorsal dislocation of the triquetrum: a case report. Ann Chir Main Memb Super1992;11(3):233-6. PMID: 1382514
  17. Ikpeme JO, Hankey S. Dorsal dislocation of the triquetrum: a rare complication of perilunate dislocation. Injury1995;26(7):497-9. PMID: 7493793
  18. Porter ML, Seehra K. Fracture-dislocation of the triquetrum treated with a Herbert screw. J Bone Joint Surg Br1991;73(2):347-8. PMID: 2005177
  19. Becce F, Theumann N, Bollmann C, et al. Dorsal fractures of the triquetrum: MRI findings with an emphasis on dorsal carpal ligament injuries. AJR Am J Roentgenol2013;200(3):608-17. PMID: 23436851
  20. Hulsopple C, Deluca J, Jonas C. Treatment of Acute Carpal Bone Fractures. Curr Sports Med Rep2017;16(5):330-335. PMID: 28902755
  21. van Onselen EB, Karim RB, Hage JJ, Ritt MJ. Prevalence and distribution of hand fractures. J Hand Surg Br2003;28(5):491-5. PMID: 12954264
  22. Hove LM. Fractures of the hand. Distribution and relative incidence. Scand J Plast Reconstr Surg Hand Surg1993;27(4):317-9. PMID: 8159947
  23. Dobyns JH, Beckenbaugh RD, Bryan RS, et al. Fractures of the hand and wrist. In: Flynn JE, editor. Hand surgery. Third ed. Philadelphia: Lippincott Williams & Wilkins; 1982.
  24. Rhemrev SJ, Ootes D, Beeres FJ, et al. Current methods of diagnosis and treatment of scaphoid fractures. Int J Emerg Med2011;4:4. PMID: 21408000
  25. Hey HW, Chong AK, Murphy D. Prevalence of carpal fracture in Singapore. J Hand Surg Am2011;36(2):278-83. PMID: 21276891
  26. Larsen CF, Brøndum V, Skov O. Epidemiology of scaphoid fractures in Odense, Denmark. Acta Orthop Scand1992;63(2):216-8. PMID: 1590062
  27. Höcker K, Menschik A. Chip fractures of the triquetrum. Mechanism, classification and results. J Hand Surg Br1994;19(5):584-8. PMID: 7822914
  28. Kellam HI, McGoey PF. Review of Fractures and Dislocations of the Carpus. Can Med Assoc J1945;53(4):332-5. PMID: 20323568
  29. Vigler M, Aviles A, Lee SK. Carpal fractures excluding the scaphoid. Hand Clin2006;22(4):501-16. PMID: 17097470
  30. Martínez-Martínez A, García-Espinosa J. Simultaneous bilateral triquetrum bone fracture. Rev Esp Cir Ortop Traumatol2017;61(4):286-288. PMID: 28216126
  31. Noordman BJ, Hartholt KA, Halm JA. Simultaneous, bilateral fracture of the triquetral bone. BMJ Case Rep2015;2015. PMID: 26392453
  32. Sluiters VP, Ritchie ED, Bosman WM. Simultaneous bilateral triquetral fractures, acquired in two separate accidents within 9 h. BMJ Case Rep2014;2014. PMID: 24759604

Reviews

  1. Pan T, Lögters TT, Windolf J, Kaufmann R. Uncommon carpal fractures. Eur J Trauma Emerg Surg2016;42(1):15-27. PMID: 26676306
  2. Papp S. Carpal bone fractures. Hand Clin2010;26(1):119-27. PMID: 20006250

Classics

  1. Durbin FC. Non-union of the triquetrum; report of a case. J Bone Joint Surg Br1950;32-B(3):388. PMID: 14778860
  2. Levy M, Fischel RE, Stern GM, Goldberg I. Chip fractures of the os triquetrum: the mechanism of injury. J Bone Joint Surg Br1979;61-B(3):355-7. PMID: 479259
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