Avulsion fractures of the scaphoid and triquetrum in a 15 year- old male

Abstract

Avulsion fractures of the perilunate ligaments occur in isolation, and multiple fractures are typically not seen in the same carpus. We present a case of a 15-year-old male who injured his wrist during football practice. He presented without wrist dislocation or deformity. Radiographs demonstrated avulsion fractures to the proximal pole of the scaphoid and proximal radial aspect of the triquetrum. The patient was immobilized with an upper extremity thumb spica cast; however, there was persistent non-union of both fractured segments. Magnetic resonance imaging confirmed avulsions at the site of the scapholunate and lunotriquetral ligaments, with both ligaments relatively intact. At the last follow-up, one year after the initial injury, the patient had a normal clinical exam, with no pain and full wrist range of motion despite fracture non-union at both locations. This is a unique injury with an unclear mechanism and complicated management.

Keywords: Carpal avulsion fractures; Scaphoid avulsion fracture; Triquetrum avulsion fracture; Wrist pain.

Fig. 1

Cartoon of Carpal bones and ligaments.

Fig. 2

PA Radiograph at initial presentation, 2 weeks after the date of injury. Arrows indicate inferior triquetrum fracture with displaced proximal pole scaphoid fracture.

Fig. 3

Magnetic Resonance Imaging (MRI) of the wrist obtained 9 months after injury. (A) Coronal gradient echo image demonstrates an intact lunotriquetral ligament attached to the avulsed triquetral fracture fragment. (B) Coronal gradient echo image demonstrates an intact scapholunate ligament attached to the avulsed proximal pole scaphoid fracture fragment.