- Symptomatic nonunion may be excised following the
season (McCue, Bruce, and Koman, 2003).
TRIQUETRUM FRACTURES
•Triquetrum fractures are common carpal bone frac-
tures in sports accounting for 3 to 4% of all carpal
bone injuries (Bryan and Dobyns, 1980).
- Fractures commonly consist of avulsion of the dorsal
cortex following hyperextension injury causing
impingement with the distal ulna.
•Treatment of this dorsal marginal fracture consists of
immobilization in short-arm cast for 3 to 4 weeks
(Geissler, 2001; Rettig et al, 1998). - Isolated fractures through the body of the triquetrum
are rare injuries and are often associated with scaphol-
unate ligamentous disruption which must be clinically
assessed (Geissler, 2001; Herzberg et al, 1993).
RETURN TOSPORTS
- Athletes may return to sport wearing a semi-rigid cast
as soon as acute pain resolves or without immobiliza-
tion when pain does not interfere with sporting activ-
ity (McCue, Bruce, and Koman, 2003; Hocker and
Menshik, 1994).
LUNATE FRACTURES
- The lunate is enclosed in the radial fossa and fracture
of the lunate is a rare entity. - Athletes present with pain and swelling over the
dorsum of the wrist. - Lunate fractures occur through either a compressive
force between the capitate and the distal radius frac-
turing through the body of the lunate or through trac-
tion from the ligamentous or capsular structures at the
extremes of motion resulting in avulsion type frac-
tures (Morgan and Reardon, 1995). - CT scan is often needed for diagnosis as the bony
architecture of the lunate is difficult to visualize on
standard radiographs. - Prompt diagnosis, immobilization, and protection from
further injury until union is evident are critical as there
is a possible association with fracture nonunion and the
development of avascular necrosis of the lunate
(Kienbock’s disease) (Beckenbaugh et al, 1980). - Nondisplaced fractures are immobilized in a short-
arm cast, with the metacarpophalangeal joints flexed
to reduce the compressive forces generated by grip-
ping, for 6 weeks. - Displaced fractures require open reduction and inter-
nal fixation versus percutaneous fixation to restore
radiocarpal and midcarpal stability as well as lunate
vascularity with immobilization continuing until frac-
ture healing is evident.RETURN TOSPORTS- Athletes may return to sport once fracture healing is
evident. Protective splinting is recommended when
athletes return to competition (Morgan and Reardon,
1995). - Close observation for signs of avascular necrosis
(dorsal wrist pain and swelling) are required follow-
ing fracture healing, so it can be caught during the
early stages when treatment options afford the best
opportunity for return to competition (Geissler, 2001;
Rettig et al, 1998).
TRAPEZIUM FRACTURES- Fractures of the trapezium constitute 1 to 5% of all
carpal fractures (Geissler, 2001; Botte and Gelberman,
1987).
•Trapezium fractures involve either the longitudinal
ridge (the attachment site for the transverse carpal lig-
ament) or the body. - Ridge fractures are usually the result of direct trauma
such as fall on outstretched hand or being struck by a
ball. - Body fractures are more common and result from
falling on outstretched thumb with resultant splitting
of the trapezium body and displacement of the thumb
carpometacarpal joint (the mirror image of the
Bennett’s fracture-dislocation). - Fractures of the body of the trapezium can often be
seen on standard AP and lateral views. A pronated PA
view can help visualize the articular surface and
detect any displacement. The carpal tunnel view is
useful to visualize trapezial ridge fractures. A CT scan
may be useful in fractures difficult to visualize with
plain radiographs. - Nondisplaced fractures of the trapezium are treated
with immobilization in a thumb spica cast for 4 to
6 weeks. Range of motion and strengthening are then
initiated with continued use of a removable thumb
spica splint for an additional 2 to 4 weeks (Morgan
and Reardon, 1995). - Body fractures are unstable and subject to displace-
ment therefore close follow-up must be maintained
until fracture union is evident (Geissler, 2001). - Displaced body fractures are managed with open
reduction and internal fixation with the use of com-
pression screws, Kirschner wires, or a combination of
both and repair of the capsular structures. Stable inter-
nal fixation allows early mobilization of the joint
314 SECTION 4 • MUSCULOSKELETAL PROBLEMS IN THE ATHLETE