Wrist pain after a fall can be unsettling, especially when the injury doesn't have an obvious name yet. If a doctor has mentioned the triquetrum, or if pain on the pinky side of the wrist has sent someone searching for answers, this guide covers everything from anatomy through recovery, including some details that most basic explainers skip entirely.
At a Glance
| Topic | Key Facts |
|---|---|
| What it is | A fracture of the triquetrum, one of eight carpal bones in the wrist |
| How common | Second most commonly fractured carpal bone; 15–18% of all carpal fractures |
| Most common type | Dorsal cortical fracture (93–95% of cases) |
| Main cause | Fall onto an outstretched hand with the wrist extended and ulnarly deviated |
| Core symptoms | Ulnar-sided wrist pain, dorsal swelling, reduced grip strength |
| Diagnosis | X-ray (multiple views); CT or MRI if X-ray is negative but fracture is suspected |
| Standard treatment | Immobilization in splint or cast for 4–6 weeks |
| Typical recovery | 6–12 weeks for most dorsal cortical fractures |
| When to seek further help | Pain persisting beyond 8 weeks warrants reassessment |
What Is the Triquetrum?
The triquetrum (also called the triquetral bone or triangular bone) is one of eight small carpal bones that form the wrist. It sits in the proximal row of carpal bones, the row closest to the forearm, on the ulnar side, meaning the side of the wrist aligned with the little finger.
The name comes from the Latin triquetrus, meaning "three-cornered," which describes its pyramidal shape. It articulates (connects) with three neighboring bones: the lunate on the radial side, the pisiform on the front (volar) surface, and the hamate below it. It also makes contact with the triangular fibrocartilage complex (TFCC), a disc-shaped structure that cushions the ulnar side of the wrist.
The triquetrum carpal bone contributes to wrist motion at two joints: the radiocarpal joint (between the forearm and wrist) and the midcarpal joint (between the two rows of wrist bones). Several strong ligaments attach to it, and those ligament forces on the bone are one of the primary causes of fracture.
Experiencing wrist pain after a fall? Find a doctor near you who can assess the injury and guide next steps.
The Three Types of Triquetrum Fractures
The triquetrum is the second most commonly fractured carpal bone, accounting for 15–18% of all carpal fractures, according to peer-reviewed research by Guo, Cardenas & Wu (Current Reviews in Musculoskeletal Medicine, 2021). Most patients are not told which type of fracture they have, but the type matters because it determines treatment, recovery length, and the likelihood of complications.
"The dorsal cortical fracture pattern is the most common type and the most well-characterized in terms of diagnosis and treatment." Source: Guo, Cardenas & Wu, Current Reviews in Musculoskeletal Medicine, 2021
Fracture Type Comparison
| Fracture Type | Location | Common Cause | Frequency | Typical Treatment |
|---|---|---|---|---|
| Dorsal cortical | Back (dorsal) surface chip | Fall with ulnar deviation; ligament avulsion | 93–95% of cases | Splint or cast, 4–6 weeks |
| Body fracture | Main mass of the bone | Higher-energy trauma | Less common | Cast; surgery if displaced or unstable |
| Volar cortical | Front (palm-side) surface | Forceful hyperflexion | Rarest type | Varies; consult a specialist |
Dorsal Cortical Fracture
This is by far the most common pattern, accounting for 93–95% of all triquetral fractures. It involves a small chip of bone breaking off the back (dorsal) surface of the triquetrum. This typically happens when the ulnar styloid process, a bony prominence at the end of the ulna, acts as a wedge against the triquetrum during a fall, or when ligament forces pull a fragment away.
Dorsal cortical fractures are generally considered benign. Most heal well with conservative management (splinting or casting) and rarely require surgery.
Body Fracture
A body fracture involves the main mass of the triquetrum rather than just a surface chip. These typically result from higher-energy trauma such as car accidents, hard falls, or forceful impact. Body fractures are more likely to occur alongside other wrist injuries, and a doctor should assess any body fracture for signs of associated instability. Published orthopedic literature reports that between 12–25% of triquetral fractures occur alongside perilunate dislocation (a disruption of carpal bone alignment), though this is more common with complex fracture patterns rather than isolated injuries.
Volar Cortical Fracture
This is the rarest type and involves the front (palm-side) surface of the bone. Clinical guidance for this pattern is less established than for the other two types, and a doctor familiar with hand and wrist injuries is best placed to advise on individual management.
Symptoms of a Triquetrum Fracture
Triquetrum pain typically presents on the ulnar side of the wrist, the pinky-finger side, and tends to worsen with wrist flexion and extension. The most common symptoms include:
- Pain on the back and ulnar side of the wrist
- Swelling over the dorsal (back) surface of the wrist
- Point tenderness directly over the triquetrum
- Reduced grip strength
- Limited wrist range of motion
The symptoms can feel similar to a wrist sprain, which is one reason this fracture is frequently under-recognized early on.
Triquetrum Fracture vs. Wrist Sprain: How to Tell the Difference
A wrist sprain and a triquetral fracture can produce overlapping symptoms, but a few features point more specifically toward fracture. Localized tenderness directly over the back of the wrist (rather than generalized soreness), pain that worsens with specific wrist movements like flexion, and a mechanism involving a fall onto an outstretched hand with the wrist extended and tilted toward the pinky all increase the likelihood of a fracture. When these features are present, imaging is typically warranted rather than watchful waiting. A doctor can assess the injury in person and determine whether X-rays are needed. An AI healthcare navigator can help triage symptoms and identify appropriate next steps.
Diagnosis: Why Triquetrum Fractures Are Frequently Missed
Standard wrist X-rays can miss a significant proportion of triquetral fractures, particularly when only a single view is used. This happens because the triquetrum is partially obscured by the pisiform on a standard front (posteroanterior) view and by the scaphoid on a lateral view, according to orthopedic imaging research by Welling et al. (American Journal of Roentgenology, 2008).
For this reason, multiple X-ray views should be taken together: posteroanterior (PA), lateral, and a 45-degree pronated oblique view. Even with all three, some fractures are only visible on the lateral view as a small chip of bone near the back of the wrist.
When clinical suspicion is high but X-rays are negative, CT scanning is the next step. CT provides cross-sectional imaging that can reveal fractures not visible on plain X-rays. MRI adds value when ligament injury is also suspected, particularly injury to the TFCC or the lunotriquetral ligament.
A negative X-ray does not rule out a triquetral fracture. A doctor who suspects one based on physical examination may order further imaging before concluding that no fracture is present.
Triquetrum Fracture Treatment
Conservative Management (Most Cases)
Most triquetral fractures, particularly dorsal cortical fractures, respond well to non-surgical treatment. The standard approach is immobilization using a volar splint (a splint applied to the palm side of the wrist) or a short-arm cast, with the wrist positioned in slight extension. Immobilization is typically maintained for 4–6 weeks for dorsal avulsion fractures and up to 6 weeks for non-displaced body fractures.
Pain typically begins to reduce within 4–8 weeks of starting treatment, according to clinical guidance from hand surgery literature. A follow-up X-ray is usually done every two weeks during this period to confirm healing progress.
When Surgery Is Considered
Surgery is generally reserved for fractures with significant displacement, fracture-dislocation (when bones are shifted out of normal position), or signs of carpal instability. Surgical options include percutaneous K-wire fixation (thin pins inserted through the skin) and open fixation using compression screws. Outcomes with either approach are generally satisfactory, though direct comparative evidence between the two methods is limited.
Open triquetral fractures, where the bone is exposed through a skin wound, require surgical irrigation, debridement (cleaning), and antibiotic treatment. A doctor will assess whether articular surfaces are involved before determining the full scope of repair.
Fibrous Nonunion
In some cases, the fractured fragment does not fully unite with the rest of the bone, a condition called fibrous nonunion. This is often asymptomatic, and most people experience meaningful pain reduction and wrist motion recovery even without complete bony union. In cases where symptoms persist, surgical removal of the fragment is an option with generally good outcomes.
Recovery: Week by Week
Recovery from a triquetral fracture follows a general sequence, though the timeline varies by fracture type, severity, and individual healing. A doctor or physiotherapist can advise on an appropriate progression for a specific case.
Phase 1: Weeks 0–4 (Immobilization)
The wrist is held in a splint or cast. During this phase, keeping the fingers, elbow, and shoulder moving is important to prevent stiffness in those joints. Finger exercises, such as gentle fist-making and spreading, can typically be done even while the wrist is immobilized.
Ice applied for 15 minutes, 3–4 times per day (not directly against the skin), can help manage swelling in the first 72 hours. Over-the-counter pain relief can be used as directed, with a pharmacist or doctor advising on suitability based on individual health history.
Phase 2: Weeks 4–6 (Progressive Movement)
As the splint is weaned or a shorter brace is introduced, gentle wrist range-of-motion exercises typically begin. These should feel like mild discomfort rather than sharp pain. Exercises at this stage focus on regaining flexion, extension, and rotation.
Phase 3: Week 6 Onward (Strengthening and Return to Activity)
From around 6 weeks, progressive strengthening exercises can begin, starting with light resistance and building gradually. Grip strength often takes longer to restore than range of motion. Sports-specific movements such as throwing, catching, and gripping can typically be introduced gradually from the 6-week mark, building up well before returning to full competition or contact sport.
Full recovery from a straightforward dorsal cortical fracture typically occurs within 6–12 weeks. Body fractures, surgical cases, or those with associated ligament injuries may require a longer timeline.
Returning to Work
For desk-based roles, many people can resume light keyboard work relatively early during the immobilization phase, depending on comfort. For manual, physical, or grip-intensive work, a return to full duties generally requires confirmed healing, typically after 6–8 weeks minimum, with modified duties in the interim. An occupational therapist can help bridge the gap between clinical recovery and full workplace function.
Returning to Sport
Athletes in sports that do not require wrist loading (running, cycling) may return earlier with appropriate splinting. Those in contact sports (rugby, hockey) or wrist-loading activities (snowboarding, skateboarding, gymnastics, climbing) should wait for confirmation of adequate healing before returning to full competition. A sports medicine doctor or physiotherapist familiar with return-to-sport protocols can advise on individual timelines.
Possible Complications
Most triquetral fractures resolve without lasting issues. For cases where recovery does not follow the expected course, a few complications are worth knowing about.
Persistent pain beyond 8 weeks can indicate a concurrent soft tissue injury. When symptoms continue past this point, orthopedic specialists may recommend MR arthrography to assess for injury to the TFCC or intercarpal ligaments, particularly the lunotriquetral ligament. These injuries can be present alongside a triquetral fracture and may need separate treatment.
Pisotriquetral arthrosis (arthritis at the joint between the pisiform and triquetrum) can develop if a fracture extends into that joint surface, or from a symptomatic nonunion. Pisiform excision is a surgical option in symptomatic cases and has been shown to produce good outcomes.
Carpal instability is uncommon but can follow body fractures or higher-energy injuries. Signs include persistent wrist pain or weakness that does not improve as expected. A hand surgeon can evaluate and advise on management.
If recovery is not progressing as expected, find a hand and wrist specialist for reassessment.
Frequently Asked Questions
What is the triquetrum? The triquetrum is one of eight small carpal bones in the wrist. It sits on the ulnar (pinky-finger) side of the proximal carpal row and articulates with the lunate, hamate, and pisiform. It plays a role in wrist motion at both the radiocarpal and midcarpal joints.
What causes a triquetrum fracture? The most common cause is a fall onto an outstretched hand, particularly when the wrist is extended and tilted toward the pinky (ulnar deviation). In this position, the ulnar styloid process can act as a wedge against the back of the triquetrum, causing a chip fracture. Ligament forces during a fall can also pull a fragment away from the bone. Higher-energy trauma such as car accidents or sports collisions can cause body fractures. Triquetral fractures are also seen in snowboarding, skateboarding, and contact sports.
How serious is a triquetral fracture? Most triquetral fractures are manageable injuries. The majority, particularly dorsal cortical fractures that account for over 90% of cases, heal well with immobilization and conservative care without requiring surgery. More complex fractures, or those associated with carpal instability or ligament injury, may need surgical management and a longer recovery period. A doctor can advise on the appropriate approach for a specific case.
Can you palpate the triquetrum? The triquetrum can be palpated (felt) during a physical examination, though it requires a specific technique. Because the bone sits beneath the ulnar styloid process and the pisiform, direct palpation is easiest when the hand is deviated toward the thumb (radial deviation). In this position, the triquetrum shifts out from under the ulnar styloid, making it more accessible on the back of the wrist. Tenderness on direct palpation over this area is one of the clinical signs that raises suspicion for a triquetral fracture.
