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

Differential Diagnoses

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

Figure 2.

Diagnosis
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.