Dorsal Fractures of the Triquetrum: MRI Findings With an Emphasis on Dorsal Carpal Ligament Injuries

Abstract

Dorsal fractures of the triquetrum are frequently associated with dorsal carpal ligament injuries. Bone marrow edema distribution is not correlated with these ligament tears.

MR Imaging of Wrist Ligaments

“…4). 65,66 Three less common variants have been described, which involve either separate bands or additional radial fibers that may cover the dorsal proximal scaphoid. 65,67 Dorsal intercarpal ligament This intrinsic capsular ligament, also known as the dorsal scaphotriquetral ligament, inserts distal to the dorsal ridge of triquetrum on its radial aspect.…”

“…65,67 Dorsal intercarpal ligament This intrinsic capsular ligament, also known as the dorsal scaphotriquetral ligament, inserts distal to the dorsal ridge of triquetrum on its radial aspect. 66 It then passes radially, where it attaches to the dorsal distal lunate and dorsal groove of scaphoid, with additional fibers attaching distally to the dorsal proximal rim of the trapezium in most wrists (Fig. 4).…”

“…85 Whether obtained via 3D reconstructions or primary 2D acquisitions, oblique planes may add significant value to assessment of intrinsic and extrinsic ligaments, which also run in oblique planes. 23,24,66,86 Fluid-sensitive pulse sequences, such as T2-weighted, T2*-weighted (GRE), short-tau inversion recovery (STIR), intermediate-weighted (long recovery time; echo time, 30-60 milliseconds), and proton density-weighted sequences, are most helpful for evaluating the wrist ligaments. 7,21,22,73,80,83 Fat suppression, whether accomplished via spectrally selective radiofrequency pulses; a phase-dependent method (Dixon technique); or, if necessary, STIR, enhances diagnostic yield (Box 1).…”

MR Imaging of Carpal Fractures

“…[46][47][48][49][50][51] Dorsal triquetral fractures can occur with a fall forward onto a palmar flexed hand or backward onto a dorsiflexed hand. [46][47][48][49] There are 2 leading theories regarding the cause of dorsal triquetral fractures.…”

“…Dorsal triquetral fractures can rarely lead to nonunion 51 ; however, they are frequently associated with ligament injuries, which can lead to instability and early arthritis. 50,51 For acute wrist injuries, the ACR AC recommend radiography as the initial imaging modality. 2 As discussed with scaphoid fractures, the initial radiographs may not allow detection of this particular carpal fracture.…”