Subba Rao Chaganti MBBS, Presenter: Nothing to Disclose

Ajay Sahu MBBS, MRCS, Abstract Co-Author: Nothing to Disclose

Carol Phillips FRCR, Abstract Co-Author: Nothing to Disclose

Simon Horne, Abstract Co-Author: Nothing to Disclose

Philip Mark Hughes MBBS, Abstract Co-Author: Nothing to Disclose

David Gay MD, Abstract Co-Author: Nothing to Disclose

To assess whether a bony flake seen dorsal to the proximal carpal row on a lateral wrist radiograph represents a fracture of the triquetrum To assess whether patient management changes if the fracture arises from a carpal bone other than the triquetrum  

Patients presenting to the Emergency Department (ED) after wrist trauma, whose radiographs showed a fracture fragment dorsal to the proximal carpal row on the lateral view of the wrist, were invited to join the study. They were seen in the ED clinic, consented for the study and a CT scan was performed within one week of injury. Where the fracture involved bones other than the triquetrum, two hand surgeons reviewed the scans independently to give advice as to management.

32 patients formed our study group. Our study showed that 63% (n=20) of the fractures originated from the triquetrum alone, 19 %( n=6) had a fracture involving other bone in addition to triquetrum (Triquetral plus), 13% (n=4) had fracture of a carpal bone other than triquetrum, and in 5% (n=2) CT demonstrated degenerative changes with calcified scapholunate ligament but no fracture. The “triquetral plus” fractures were triquetral and distal radius fracture (n=3), triquetral and scaphoid (n=1), triquetral and 1st metacarpal (n=1) and triquetral and ulnar styloid (n=1). None of these additional injuries were apparent on the plain films. All the patients with fractures involving triquetral or other carpal bones were treated conservatively with 4 weeks of cast immobilisation.  

Our study demonstrated that not all flake fractures come from the triquetrum and some flake fractures of the triquetrum were associated with other carpal fractures that were not apparent on the plain films. The fact that all these patients were treated similarly irrespective of the origin of the flake fracture means that CT of these fractures is not recommended routinely but it should be considered if a more complex fracture is suspected.

Ossific flakes seen on the wrist radiographs should be viewed in the context of mechanism of injury and should not be merely labelled as triquetral fractures.  

Chaganti, S, Sahu, A, Phillips, C, Horne, S, Hughes, P, Gay, D, Do Flake Fractures All Come from the Triquetrum?.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12043541.html