A 28-Year-Old Boxer with Wrist Pain After a Bout

Differential Diagnosis

• Enthesopathy of the flexor carpi ulnaris
• Pisotriquetral osteoarthritis
• Transverse fracture of the distal triquetrum body

Diagnosis

This patient suffered a transverse fracture of the distal triquetrum body secondary to the impact of punching. This is the second most common carpal bone fracture, accounting for up to 15% of all carpal fractures.

Learnings/What to Look for

• There are two types of triquetral bone fractures: avulsion (cortex) fractures and fractures of the triquetral body
• The most common mechanism of injury for triquetral avulsion fracture is a dorsal cortical fracture resulting from direct impact with the wrist in dorsiflexion and ulnar deviation, which may occur in a fall onto an outstretched hand; volar/palmar cortical fractures are rare
• Types of fractures of the triquetral body
  • Sagittal fractures ─ seen in axial dislocations or anterior-posterior crush injury
  • Medial tuberosity fractures ─ seen in direct-blow injuries
  • Transverse proximal pole fractures ─ seen in impact injuries and associated with perilunate dislocations
  • Transverse body fractures ─ seen in impact injuries and associated with perilunate dislocations(not present in this case)
  • Comminuted fractures ─ seen in high-energy trauma

Pearls for Urgent Care Management

• Immobilization in a short arm cast for 4 to 6 weeks is indicated for dorsal and palmar cortical fractures without evidence of instability and nondisplaced body fractures
• Surgery will be required for dorsal and palmar cortical fractures where there is evidence of instability and displaced body fractures

Acknowledgment: Image and case presented by Experity Teleradiology (www.experityhealth.com/teleradiology).