A 20-year-old male presented with left wrist pain after sliding head first into second base during a baseball game. On examination, there was swelling over the dorsal surface of the wrist with tenderness over the distal ulnar styloid process and limited range of motion due to pain. An x-ray revealed an avulsion fracture of the dorsal ridge of the triquetrum bone. The patient was prescribed pain medication, wrist splinting for 4-6 weeks, and a follow-up with orthopedic surgery.

2.  20 YOM presents with left
wrist pain. Pt was playing
baseball. He was sliding
into second base head first
and when his left hand
impacted the base he had
immediate pain. He is able
to move his wrist but has
moderate pain. There is
swelling over the dorsal
surface of his wrist.
 T 98.7 P 102 BP 126/84 O2




99%
Gen: WDWN, obvious pain
CV: Tachycardic, RR, no
m/r/g
Pulm: Lungs CTA bilat
Musc: L wrist swelling over
the dorsal surface; TTP just
distal to the ulnar styloid
process; limited ROM 2/2
pain

4.  Avulsion fracture of the dorsal ridge of the triquetrum

5.  Pain Control
 Reduction/Stabilization
 Splinting of the wrist with volar splint for 4-6 weeks
 Orthopedic surgery follow up for re-evaluation and
possible ORIF for displaced triquetral body fractures
(associated with significant ligamentous injury)

6.  Second most common fracture of the carpal bones
 Results from either direct blow on dorsal surface or fall
on outstretched hand (FOOSH, believed to impact the
triquetrum against the ulnar styloid process)
 May be difficult to identify. May only be visualized as a
small fleck on the lateral view

8.  http://www.feinberg.northwestern.edu/emergencyme




d/residency/orthoteaching/wrist/case30/case30histor
y-physicalexam.html
http://nypemergency.org/radiology/radiology_2011/ca
se-of-the-month-0211.html
http://radiographics.rsna.org/content/28/6/1771.figure
s-only
http://www.abhamed.net/uploads/DOCS/Books/Radi
ology/MER2/htm/MER2/HTML/206.htm
Rosen’s Emergency Medicine. Chapter 48 Wrist and
Forearm.