Overview
Open fracture dislocation of the wrist involves complex injuries to the carpal bones, often including the triquetrum, with potential for neurovascular compromise and significant functional impairment 1.Diagnosis
Key Diagnostic Criteria: Identification of triquetrum fractures, often dorsal or volar patterns, and associated carpal bone fractures 1.
Recommended Tests: Three-dimensional extremity computed tomography (CT) for detailed fracture pattern analysis 1.
Grading: Fracture classification systems (e.g., AO/OTA classification) may help in assessing severity and guiding management 1.Management
First-Line Treatments: Open reduction and internal fixation (ORIF) for complex fractures involving multiple carpal bones 3.
Adjunctive Treatments: Early mobilization and physiotherapy to prevent stiffness and optimize function 3.
Specific Considerations: Excision of fractured hook of the hamate for isolated fractures in specific populations like competitive golfers 2.Special Populations
Pediatrics: Awareness of scaphocapitate syndrome in children with distal radius and ulna fractures; prompt ORIF can prevent complications like avascular necrosis 3.
Comorbidities: No specific evidence provided for management adjustments in elderly or comorbid patients 132.Key Recommendations
Utilize three-dimensional extremity CT for comprehensive evaluation of triquetrum and associated carpal fractures to guide surgical planning (Evidence: Moderate 1).
Perform open reduction and internal fixation for complex wrist fractures involving the triquetrum and other carpal bones to ensure anatomical reduction and functional recovery (Evidence: Expert opinion 3).
Consider excision of the fractured hook of the hamate in competitive golfers with isolated hook fractures to facilitate rapid return to sport (Evidence: Weak 2).References
1 Oh E, Kim HJ, Hong S, Hwang J, Lim H, Park S et al.. Evaluation for fracture patterns around the wrist on three-dimensional extremity computed tomography, especially focused on the triquetrum. Journal of medical imaging and radiation oncology 2015. link
2 Aldridge JM, Mallon WJ. Hook of the hamate fractures in competitive golfers: results of treatment by excision of the fractured hook of the hamate. Orthopedics 2003. link
3 Mazur K, Stevanovic M, Schnall SB, Hannani K, Zionts LE. Scaphocapitate syndrome in a child associated with a distal radius and ulna fracture. Journal of orthopaedic trauma 1997. link