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Differential Diagnoses

  • Distal radius fracture
  • Extensor carpi ulnaris subluxation
  • Lunatotriquetral ligament injury
  • Triquetral Avulsion Fracture
  • Ulnar extrinsic ligament tear

A 41-Year-Old Woman with Wrist Pain After Falling

Figure 2.

The image shows that the patient suffered a triquetral avulsion fracture. This is the second-most common fracture involving the carpal bone (the scaphoid being the most common).

Learnings/What to Look for

  • Mechanism for triquetral avulsion fracture is often a fall onto an outstretched hand in ulnar deviation
  • This fracture can be subtle and is usually visible only on the lateral view
  • Typically, this is seen as an avulsed flake of bone, identified lying posteriorly to the triquetral bone in the dorsal mid-wrist

Pearls for Urgent Care Management and Considerations for Transfer

  • The wrist should be placed in a cast, either in the urgent care center or by an orthopedic specialist, for approximately 6 weeks
  • Rarely, surgical intervention may be necessary. A persistently symptomatic chip fracture may require excision
  • Posttreatment, the patient should receive physical therapy

Acknowledgment: Images courtesy of Teleradiology Specialists.

A 41-Year-Old Woman with Wrist Pain After Falling
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