Guo Raymond C, Cardenas Justin M, Wu Chia H
Department of Orthopedic Surgery, Baylor College of Medicine, 7200 Cambridge Street, Houston, TX, 77030, USA.
Curr Rev Musculoskelet Med. 2021 Apr;14(2):101-106. doi: 10.1007/s12178-021-09692-w. Epub 2021 Jan 23.
The triquetrum is the second most commonly fractured carpal bone, comprising 15-18% of all carpal bone fractures. This review summarizes the current knowledge of triquetral fractures, including the anatomy and pathophysiology, evaluation and diagnosis, treatment and management, post-treatment outcomes, and complications.
Triquetral fractures are frequently caused by impaction of the ulnar wrist after a fall on an outstretched hand or by avulsion of attached ligaments. There are three main types of triquetral fractures: dorsal cortical fractures, triquetral body fractures, and volar cortical fractures. Dorsal cortical fractures are the most common and are usually benign, while volar cortical fractures are the least common and can be problematic. Nonsurgical management is indicated for most triquetral fractures, which usually results in good outcomes. Surgical treatment is indicated for fractures with significant displacement or evidence of instability. Complications of triquetral fractures include non-union, triangular fibrocartilage complex injury, and pisotriquetral arthritis. While less common than scaphoid fractures, triquetral fractures should remain in the differential diagnosis for patients with ulnar-sided wrist pain after falling on an outstretched hand. Most triquetral fractures can be treated with immobilization, though they should be thoroughly evaluated due to their potential to result in instability, loss of motion, and arthrosis. Further research is needed to determine the best method of surgical treatment.
三角骨是第二常见的腕骨骨折部位,占所有腕骨骨折的15% - 18%。本综述总结了目前关于三角骨骨折的知识,包括解剖结构与病理生理学、评估与诊断、治疗与管理、治疗后结果以及并发症。
三角骨骨折常由手部伸展位摔倒时尺侧腕部受到撞击或附着韧带的撕脱所致。三角骨骨折主要有三种类型:背侧皮质骨折、三角骨体骨折和掌侧皮质骨折。背侧皮质骨折最为常见,通常预后良好,而掌侧皮质骨折最少见,可能会出现问题。大多数三角骨骨折采用非手术治疗,通常效果良好。对于有明显移位或不稳定迹象的骨折则需手术治疗。三角骨骨折的并发症包括不愈合、三角纤维软骨复合体损伤和豌豆三角骨关节病。虽然三角骨骨折比舟骨骨折少见,但对于手部伸展位摔倒后尺侧腕部疼痛的患者,仍应将其纳入鉴别诊断。大多数三角骨骨折可通过固定治疗,不过鉴于其可能导致不稳定、活动丧失和关节病,仍需进行全面评估。需要进一步研究以确定最佳的手术治疗方法。