SUMMARYTriquetral fractures are the second most common carpal fractures. Triquetral body fractures are the less common type of triquetral fractures but they can be missed on plain radiographs and a non-union can be associated with considerable morbidity and reduction in functional activities. We report a unique case of displaced isolated triquetral body fracture that was initially missed on plain radiographs and resulted in non-union. The fracture non-union was diagnosed on magnetic resonance imaging and was treated successfully with open reduction and internal fixation using compression screws, without bone grafting, and early mobilisation of the wrist allowing a return to premorbid activity levels. To our knowledge, this has not been previously described in the literature. We advocate early clinical suspicion of triquetral fractures in patients with persistent ulnar-sided wrist pain following trauma, and early evaluation using computed tomography or magnetic resonance imaging.

First metatarsalphalangeal joint arthrodesis is a well established and successful treatment; however there still remains controversy over the best choice of construct. We performed a retrospective study of patients undergoing first metatarsalphalangeal fusion over eighteen months (n=52) using either dorsal non-locking plate with additional compression lag screw fixation or dorsal non-locking plate alone. We found when assessing clinical criteria, patients with dorsal non-locking plates and additional compression lag screw fixation had a significantly higher rate of fusion (100% vs 77.8%), significantly higher rate of fusion within the first two months (55.6% vs 83.3%), significantly earlier time to fusion (52.2 days vs 75.6 days), and significantly lower rate of non-union (0% vs 22.2%). When blindly assessing radiographic criteria, the patients treated with the plate and compression screw had a significantly higher rate of fusion and lower rate of non-union (0% vs 33%). There was no statistically significant difference between the frequencies of complications in the groups. We believe that the interfragmentary compression is a crucial factor in achieving good union rates and recommend the use of non-locking pre-contoured plating with additional interfragmentary compression screw as the fixation method of choice for these procedures.