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Contents
  • The Limitations of Standard X-rays
  • Advanced Imaging: CT and MRI
  • The Role of Cone Beam CT
  • Clinical Examination: The First Step

Diagnosing Triquetrum Fractures: Why X-rays Aren't Always Enough

Diagnosing Triquetrum Fractures: Why X-rays Aren't Always Enough

The Diagnostic Challenge

Triquetrum fractures can be tricky to diagnose, often eluding detection on standard X-rays. Understanding the full range of diagnostic tools is crucial for accurate identification and proper treatment.
Contents
  • The Limitations of Standard X-rays
  • Advanced Imaging: CT and MRI
  • The Role of Cone Beam CT
  • Clinical Examination: The First Step

The Limitations of Standard X-rays

While X-rays are typically the first line of imaging for suspected wrist fractures, they have a surprisingly low sensitivity for triquetrum fractures. Studies show that standard radiographs may miss up to 70-80% of these fractures. This is partly due to the small size of the triquetrum and its position in the wrist, which can make fractures difficult to visualize on standard views.

Advanced Imaging: CT and MRI

When X-rays are inconclusive but clinical suspicion remains high, advanced imaging techniques come into play. Computed Tomography (CT) scans provide detailed 3D images of the bone, making them highly effective at identifying fractures. Magnetic Resonance Imaging (MRI) goes a step further, showing not only bone injuries but also damage to surrounding soft tissues like ligaments.
A triquetrum fracture is a break in one of the small carpal bones in the wrist, often difficult to detect with standard X-rays. Advanced imaging like CT and MRI may be required for accurate diagnosis.

The Role of Cone Beam CT

Cone Beam CT (CBCT) is an emerging technology that's particularly useful for diagnosing carpal fractures. It provides high-resolution images with less radiation exposure than standard CT. CBCT has shown superior sensitivity in detecting radiocarpal fractures compared to plain radiographs, making it an excellent option when triquetrum fracture is suspected.

Clinical Examination: The First Step

Before any imaging, a thorough clinical examination is crucial. The physician will look for point tenderness over the triquetrum, typically 1-2 cm distal to the ulnar styloid. They may also perform specific maneuvers to stress the triquetrum and elicit pain. This clinical assessment guides the decision on which imaging studies to pursue.

FAQs

Why are triquetrum fractures often missed on X-rays?

The bone's small size and position can make fractures difficult to see on standard views.

Is CT or MRI better for diagnosing triquetrum fractures?

CT is excellent for bone detail, while MRI is superior for soft tissue injuries.

How accurate is Cone Beam CT for triquetrum fractures?

CBCT shows high accuracy and is becoming increasingly favored for carpal fracture diagnosis.

Can ultrasound be used to diagnose triquetrum fractures?

While not typically used, ultrasound can sometimes detect fractures and is useful for soft tissue injuries.

How long after injury should imaging be done?

Immediate imaging is best, but fractures can often be detected even weeks after injury.

The Bottom Line

Accurate diagnosis of triquetrum fractures often requires a combination of clinical examination and advanced imaging techniques.
If you suspect a triquetrum fracture, consult with Doctronic to determine the most appropriate diagnostic approach for your situation.
Additional References
  1. Welling RD, et al. AJR Am J Roentgenol 2008; 190:10.
  2. Balci A, et al. Emerg Radiol 2015; 22:251.
This article has been reviewed for accuracy by one of the licensed medical doctors working for Doctronic.