Triquetral Avulsion Fracture
Jacksonville, FL
A fall or twisting injury to the wrist produces pain on the ulnar (pinky) side, and the X-ray shows a small chip of bone on the back of the wrist. That's a triquetral avulsion fracture — the second most common carpal fracture after the scaphoid. Dr. R. David Graham at JOI is direct about this: the chip doesn't change the treatment. It's managed exactly like a wrist sprain.
- Second most common carpal fracture after the scaphoid
- Small dorsal cortical chip — ligament attachment avulsion
- Treatment is identical to a wrist sprain: brace + PT
- The fracture itself doesn't change management
- Reassure the patient: the chip heals fine in place
- No surgery required for isolated dorsal avulsion fractures
The triquetral avulsion chip looks alarming on X-ray but it heals reliably in place without surgery. The treatment is brace and PT — same as a wrist sprain.
What Happened
A Chip Off the Back of the Wrist
The triquetrum is one of eight carpal bones — it sits on the ulnar (pinky) side of the wrist, articulating with the pisiform in front and the hamate below. On the dorsal (back) surface, several ligaments attach to the triquetrum, including fibers of the dorsal radiocarpal and dorsal intercarpal ligaments. When the wrist is forced into extreme flexion or extension — a fall, a direct blow — these ligaments can pull a small cortical fleck off the dorsal surface of the triquetrum.
This is a triquetral avulsion fracture. It is the second most common carpal fracture after the scaphoid, and it is treated nothing like a scaphoid fracture. The dorsal chip is a ligament avulsion — the fragment is typically small, cortical, and extraarticular. It heals reliably in place without surgical fixation, and without cast immobilization.
In Dr. Graham's experience, the treatment is brace and PT — exactly what would be done for a wrist sprain. The fracture itself does not change the management compared to a pure ligament injury at the same location. Patients are reassured that the chip will heal fine, the brace is worn for 4–6 weeks, and therapy is initiated for grip strength and wrist motion.
The one caveat worth knowing: a triquetral avulsion fracture can occasionally be the visible sign of a larger wrist ligament injury — particularly if ulnar-sided wrist pain persists beyond 6–8 weeks. In that setting, MRI arthrogram is ordered specifically evaluating the LT ligament and TFCC, which share the same anatomic neighborhood as the triquetrum.
- ✓ Triquetral avulsion: dorsal chip, ulnar side, extraarticular — brace and move it
- ✓ Scaphoid fracture: anatomic snuffbox tenderness, can be invisible on X-ray — CT/MRI required
- ✓ The triquetral chip heals in place without surgery
- ✓ Scaphoid nonunion can occur if missed — treatment urgency is completely different
- ✓ Both can occur together in higher-energy wrist trauma
If there is any clinical concern for a concurrent scaphoid fracture — anatomic snuffbox tenderness — that concern is addressed specifically regardless of the triquetral finding.
Treatment
Brace, PT, and Reassurance
The triquetral avulsion fracture is treated like a wrist sprain because it is, functionally, a wrist sprain with a visible bony correlate.
Why No Surgery for the Chip
The dorsal avulsion fragment is small, cortical, and not part of the weight-bearing articular surface of the triquetrum. It does not need to be anatomically reduced and fixed — it will fibrose and heal in place in the surrounding soft tissue, producing a stable outcome. The underlying ligament injury heals with the same brace and PT protocol as any other wrist sprain.
The fragment on X-ray is not the injury that needs treating — the ligament pull that produced it is. And ligament injuries in this location heal with brace and PT. Patients sometimes arrive expecting that the fracture requires a cast or surgery because bones are involved. The honest answer is that this particular fracture, in this particular location, does not.
Brace
Removable cock-up wrist brace. Pain managed with NSAIDs or acetaminophen. Activity as tolerated within pain limits.
PT Begins
Formal therapy for wrist motion and grip strength. Brace weaned as strength returns. Most patients are comfortable without the brace by 4–6 weeks.
Reassessment
If not improving — persistent ulnar wrist pain, weakness, or clicking — MRI arthrogram ordered to evaluate LT ligament and TFCC.
Full Recovery
Most patients are back to full activity by 2–3 months. The chip is no longer visible as a distinct fragment on follow-up X-ray — it has incorporated into the surrounding tissue.
FAQs
Frequently Asked Questions
Related Conditions
Next Steps
Dorsal wrist chip fracture —
brace, PT, and reassurance.
A triquetral avulsion fracture heals without surgery. If you've been told you have a chip fracture and you're uncertain about what to do next, Dr. Graham can confirm the diagnosis and get you started on appropriate treatment. Walk-ins welcome via JOI Now.
Jacksonville Beach, FL 32250
No imaging required.