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The morphology of the proximal carpals (scaphoid, lunate, triquetrum) are linked to the range of motion (ROM) at the radiocarpal and midcarpal joints. While the relationship between ROM and habitual locomotor mode is well established, it has yet to be investigated whether relative patterns of internal bone architecture reflect the kinematics and kinetics at the proximal row. As internal bone is known to model its structure to habitually incurred forces, internal architecture has the potential to provide insight into how a joint(s) have been loaded during the lifetime of an individual. Using a broad sample of extant great apes and humans (n=177 total), this study investigates whether relative differences in the bone volume to total volume (BV/TV) and degree of anisotropy (DA) across the scaphoid, lunate and triquetrum correlate with the presumed force transfer and biomechanics of the hominoid wrist. Results reveal broad patterns in BV/TV and DA differentiated hominoids by their predominant locomotor mode. The human pattern suggests the lunate may be the most highly strained bone within the proximal row. Both knuckle-walking taxa (Gorilla, Pan) exhibited similar architectural patterns suggesting they are adapted to resist similar forces in this region of the wrist. The relatively high DA across all Pongo carpals suggests it may have more stereotypical wrist loading than commonly assumed. Finally, the distinctly low DA in the triquetrum across all taxa suggests force transfer via the synapomorphic Triangular Fibrocartilage Complex may leave a distinctive signature in the internal bone architecture that requires further investigation.

In this study, we want to investigate the covariation in the shape of two carpal bones, the triquetrum and hamate, and the possible association with locomotor behavior in a broad range of primate taxa. We applied 3D Geometric Morphometrics on a large data set comprising 309 anthropoid primates of 12 different genera. Principal component analyses were performed on the covariance matrix of 18 (triquetrum) and 23 (hamate) Procrustes-aligned surface landmarks. A two-block partial least square analysis was done to test the covariance between triquetrum and hamate shape, without relying on the predictive models implicit in regression analyses. The results show that the carpal shape of quadrupedal anthropoids, which mainly use their wrist under compressive conditions, differs from that of suspensory primates as their wrist is possibly subjected to tensile and torsional forces. Within the hominids, differences in shape also distinguish more terrestrial from more arboreal species. Even within the great apes, we are able to capture shape differences between species of the same genus. In combination with behavioral and biomechanical studies, the results of this research can be used to establish form-function relationships of the primate hand which will aid the functional interpretation of primate fossil remains.

Background We hypothesize that different positions of the wrist in the coronal plane makes the carpus susceptible to ulnar impaction. Methods We prospectively enrolled 10 adult volunteers and obtained fluoroscopic images of each wrist in 12 different positions using a standardized protocol. Distances from the ulna to the lunate (UL) and ulna to the triquetrum (UT) were digitally measured as was the portion of the lunate surface area that was uncovered (LUR) with wrist deviation. Results A wrist position of Pronation, Neutral Deviation, and Grip (P-ND-G) significantly shortened the ulnocarpal distance when compared to a position of Neutral Rotation, Neutral Deviation, and No Grip (NR-ND-NG). Radial deviation during pronation and gripping (Pronated, Radial Deviation, Gripping [P-RD-G]) resulted in the lowest mean UL distance (1.2 mm). UT distance was minimized by a position of ulnar deviation during a pronated grip (Pronated, Ulnar Deviation, Gripping [P-UD-G]) (3.1 mm). The lunate becomes more uncovered with radial deviation. Conclusion Radial deviation minimizes the UL distance while ulnar deviation minimizes the UT distance during a wrist position of pronation and gripping. Further, there is more proximal lunate surface area uncoverage during all positions of radial deviation compared to ulnar deviation.

To develop and evaluate a two-stage deep convolutional neural network system that mimics a radiologist’s search pattern for detecting two small fractures: triquetral avulsion fractures and Segond fractures. We obtained 231 lateral wrist radiographs and 173 anteroposterior knee radiographs from the Stanford MURA and LERA datasets and the public domain to train and validate a two-stage deep convolutional neural network system: (1) object detectors that crop the dorsal triquetrum or lateral tibial condyle, trained on control images, followed by (2) classifiers for triquetral and Segond fractures, trained on a 1:1 case:control split. A second set of classifiers was trained on uncropped images for comparison. External test sets of 50 lateral wrist radiographs and 24 anteroposterior knee radiographs were used to evaluate generalizability. Gradient-class activation mapping was used to inspect image regions of greater importance in deciding the final classification. The object detectors accurately cropped the regions of interest in all validation and test images. The two-stage system achieved cross-validated area under the receiver operating characteristic curve values of 0.959 and 0.989 on triquetral and Segond fractures, compared with 0.860 (p = 0.0086) and 0.909 (p = 0.0074), respectively, for a one-stage classifier. Two-stage cross-validation accuracies were 90.8% and 92.5% for triquetral and Segond fractures, respectively. A two-stage pipeline increases accuracy in the detection of subtle fractures on radiographs compared with a one-stage classifier and generalized well to external test data. Focusing attention on specific image regions appears to improve detection of subtle findings that may otherwise be missed.

PURPOSE OF REVIEW: The triquetrum is the second most commonly fractured carpal bone, comprising 15–18% of all carpal bone fractures. This review summarizes the current knowledge of triquetral fractures, including the anatomy and pathophysiology, evaluation and diagnosis, treatment and management, post-treatment outcomes, and complications. RECENT FINDINGS: Triquetral fractures are frequently caused by impaction of the ulnar wrist after a fall on an outstretched hand or by avulsion of attached ligaments. There are three main types of triquetral fractures: dorsal cortical fractures, triquetral body fractures, and volar cortical fractures. Dorsal cortical fractures are the most common and are usually benign, while volar cortical fractures are the least common and can be problematic. Nonsurgical management is indicated for most triquetral fractures, which usually results in good outcomes. Surgical treatment is indicated for fractures with significant displacement or evidence of instability. Complications of triquetral fractures include non-union, triangular fibrocartilage complex injury, and pisotriquetral arthritis. SUMMARY: While less common than scaphoid fractures, triquetral fractures should remain in the differential diagnosis for patients with ulnar-sided wrist pain after falling on an outstretched hand. Most triquetral fractures can be treated with immobilization, though they should be thoroughly evaluated due to their potential to result in instability, loss of motion, and arthrosis. Further research is needed to determine the best method of surgical treatment.

Highlights • Knowledge of type III complete fusion is essential to the proper diagnosis and management of this variation. • Imaging modalities can easily diagnose in type III complete lunotriquetral coalition without pathological evidence. • The lunotriquetral coalition provides an enhanced understanding of unexplained carpal wrist pain or trauma. Surgical treatment of fusion has revealed pain relief, restored mobility, and acceptable postoperative wrist motion effects. • Comprehensive postoperative rehabilitation is required to ensure optimal improvement., Introduction The lunotriquetral coalition is the fusion of the lunate and triquetral bones of the wrist and is the most frequent carpal coalition type. It is frequently asymptomatic and discovered as an incidental due to chronic wrist pain, trauma, or fracture. This case aims to present an unusual unilateral lunotriquetral coalition and clinical significance for diagnosis and treatment. Presentation of case In this case, we presented a 37-year-old male who exhibited with right-sided trauma and wrist pain. He was diagnosed to had a type III complete osseous lunotriquetral coalition on the right side and detected by plain radiography and CT without lytic, destructive, and sclerotic lesions. Discussion An avulsion fracture was recognized in the distal end of the right radius. A fragmented fracture was identified in the scaphoid bone, and an internal fixator extending from scaphoid bone to lunate bone. The internal fixators were observed among the lunate, capitate, and distal end of the radius bones. The plain anteroposterior, lateral radiograph and CT of the right wrist exhibited a right-sided unilateral type III osseous coalition between the lunate and triquetrum bones. Conclusion Knowledge of type III complete fusion is essential to the proper diagnosis and management of this variation when a subject exhibits unexplained wrist pain, trauma, or fracture. It should be noted that plain radiographs and CT can provide an accurate diagnosis in type III complete lunotriquetral coalition without pathological evidence.

Objectives This study aims to evaluate the clinical and radiological outcomes of diamond-shaped Kirschner (K)-wire fixation for the treatment of acute perilunate dislocation (PLD) or trans-scaphoid perilunate fracture dislocation (PLFD). Patients and methods We performed a retrospective review of 18 patients (18 wrists; 17 males, 1 female; mean age 31.5±2.6 years; range, 18 to 47 years) treated for PLD/PLFD using a dorsal approach with the diamond-shaped K-wire fixation between November 2001 and September 2017. The mean follow-up of cohort was 27 (range, 13 to 74) months. Using a dorsal approach, open ligament repair and bone fixations were performed. Perilunate dislocation was reduced and the carpal bones and midcarpal joint were held in anatomical position using four K-wires transfixing the scapholunate (SL), lunotriquetral, scaphocapitate, and triquetrohamate joints in such a shape that each bone received two K-wires. Results The mean range of motion and grip strength measured using a Jamar® dynamometer of the injured wrist compared to the uninjured extremity were 84.3% and 78.8%, respectively. The mean Mayo wrist score was 78.3 (range, 70 to 90). The mean Visual Analog Scale score was 1.2 (range, 0 to 4). The average SL gap at the final follow-up evaluation was 1.62 (range, 1 to 2.3) mm. The mean SL and capitolunate angles were 49.3° (range, 40 to 75°) and 4.2° (range, 2 to 12°), respectively. Conclusion Because every bone is fixed with two K-wires using this configuration, a closed ring is created; hence no motion is possible between the scaphoid, capitate, hamate, triquetrum, lunate and the midcarpal joint. We believe that diamond-shaped fixation may provide reliable fixation and satisfactory clinical outcomes in patients with PLD and PLFD.

Avulsion fractures of the perilunate ligaments occur in isolation, and multiple fractures are typically not seen in the same carpus. We present a case of a 15-year-old male who injured his wrist during football practice. He presented without wrist dislocation or deformity. Radiographs demonstrated avulsion fractures to the proximal pole of the scaphoid and proximal radial aspect of the triquetrum. The patient was immobilized with an upper extremity thumb spica cast; however, there was persistent non-union of both fractured segments. Magnetic resonance imaging confirmed avulsions at the site of the scapholunate and lunotriquetral ligaments, with both ligaments relatively intact. At the last follow-up, one year after the initial injury, the patient had a normal clinical exam, with no pain and full wrist range of motion despite fracture non-union at both locations. This is a unique injury with an unclear mechanism and complicated management.

The concurrence of tears of the scapholunate (SL) and lunotriquetral (LT) ligaments is not unusual and can also occur without an apparent perilunate dislocation. Badia and Khanchandani called this combined lesion a "floating lunate" because the ligamentous attachments on both sides of the lunate are absent and the lunate floats in a neutral position. There have been few published papers referring to the treatment of this kind of instability. In recent years, we have developed an arthroscopic ligamentoplasty for SL instability. However, this procedure is not indicated whether the LT ligament is also damaged. With this current modification, both the strongest portions of the SL and LT ligaments can be reconstructed without opening the joint, thereby avoiding an open approach. We have described this as an "S"-shaped ligamentoplasty, as the graft resembles an "S" as it travels inside the scaphoid, lunate, and triquetrum. The same postoperative early mobilization protocol can be applied to this kind of reconstruction.

Carpal fractures of bones other than the scaphoid occur at a much lower rate than scaphoid fractures. The close relationship between the carpus, intrinsic and extrinsic wrist ligaments, and wrist kinematics makes a thorough history, clinical examination, and interpretation of imaging for carpal malalignment essential. Carpal malalignment should be addressed with reduction and fixation. Nondisplaced fractures are often treated nonoperatively and displaced intraarticular fractures are almost always treatment operatively. The physician should keep in mind the athlete's specific goals and needs. Treatment must be individualized. Options for early return to play should be discussed when possible.

Background This study aimed to compare CT and XR images of patients admitted to the emergency department due to wrist injuries and to evaluate the accuracy of XR in the diagnosis of fractures. Methods Patients; who admitted to ED with injuries due to wrist trauma and who underwent XR imaging and CT scans in the period from 1 January 2017 to 1 January 2018, were included in the study. CT scan image interpretation reports recorded in the hospital automation system were considered eligible to be included in the study. XR images were interpreted by an orthopedics and traumatology specialist. The sensitivity (Sn), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV) and Kappa (κ) coefficient of XR were calculated according to CT. Inter-rater agreement was graded according to κ values. Results A total of 274 patients were included in the study. Fractures were identified in the XR images in 180 (66%) patients and in the CT images in 196 (72%) patients. Compared to CT, the Sn, Sp, PPV, NPV and κ coefficient of XR were 89%, 92%, 97%, 77% and 0.764 respectively. Compared to CT, the highest sensitivity of XR was measured to detecting radius (Sn: 95%, κ: 0.896) and 5th metacarpal fractures (Sn: 77%, κ: 0.859), the lowest sensitivity of XR was calculated in detecting scaphoid, capitate, pisiform, trapezium hamate, and triquetrum fractures (Sn: 59-14%, κ: 0.619-0.240). The sensitivity and κ coefficient of XR were calculated 54% and 0.530 in the adjacent bone fracture, 83% and 0.830 in joint dislocation, 75% and 0.661 in the fractures extending to the joint space. Conclusions XR is the first-choice imaging modality in the evaluation of wrist injuries, but CT imaging should be preferred when fractures extending to the joint space, adjacent bone fracture and carpal bone fracture are being considered.

The aim of this study was to evaluate the long-term outcomes of capitolunate arthrodesis for treating advanced wrist osteoarthritis. The arthrodesis procedures were performed in three women and seven men having a mean age of 59years (range, 20-70). Eight of the patients were manual laborers. The dominant hand was operated on in seven patients. The osteoarthritis was attributed to scapholunate dissociation (SLAC) in six patients and scaphoid nonunion (SNAC) in four patients. The arthrodesis site was stabilized with two vertical compression screws. Patients were reviewed after an average follow-up of 122months (80-172). The clinical and radiological outcomes consisted of measuring pain on a visual analog scale (VAS), determining the QuickDASH and PRWE scores, the patients' satisfaction, the radiolunate and capitolunate angles, carpal height, radiolunate joint condition, and fusion of the arthrodesis site. The mean pain level was reduced from 5 to 1 (P

Purpose: Lunocapitate arthrodesis is a motion-preserving salvage procedure for painful wrist osteoarthritis. Because the arthrodesis is limited to the capitate and the lunate, the adaptive motion of the triquetrum is theoretically maintained. We aimed to examine whether triquetral motion is sustained in vivo after lunocapitate arthrodesis. Methods: We examined 7 patients after lunocapitate arthrodesis at least 1 year earlier, with computed tomography at 2 wrist positions: maximal radial extension and maximal ulnar flexion. Triquetral motion in vivo was analyzed using volume registration technique of the paired computed tomography scans and compared with the contralateral side. Results: The triquetrum moved in all patients, but the degree of motion was small compared with the nonsurgical wrist. A minor degree of motion of the hamate relative to the fused lunocapitate could also be demonstrated. Conclusions: Triquetral motion is limited after lunocapitate arthrodesis. Type of study/level of evidence: Therapeutic IV. Key words: lunatocapitate arthrodesis, osteoarthritis, scapholunate advanced collapse, scaphoid nonunion advanced collapse, triquetrum

Carpal instability secondary to scapholunate (SL) ligament tears can lead to a significant disability of the wrist. Different surgical procedures have been proposed to treat SL instability. A variety of dorsal capsulodesis techniques tethering the scaphoid have been used in patients with SL dissociation. We report a novel technique of modified dorsal intercarpal ligament (DICL) capsulodesis for the treatment of SL dissociation. The surgical indication for this procedure is complete SL ligament tear with a reducible carpal malalignment and no secondary osteoarthritis. This procedure is indicated when the remnant of torn ligament in the dorsal SL interosseous space is available for repair. First, carpal malalignment is corrected and the scaphoid and the lunate are temporarily fixed with a transosseous screw or Kirschner wires. Using a dorsal approach, the DICL is then exposed, which originates from the triquetrum and attaches to the scaphoid, trapezium, and trapezoid. The distal and proximal borders of the ligament are identified and elevated without detaching the attachment sites. The DICL is transferred proximally to reinforce the dorsal SL interosseous ligament. The wrist joint is immobilized for 3 weeks postoperatively, and dart-throwing motion is permitted until temporary SL fixation is removed at 2 to 3 months after surgery. A wrist brace is recommended until 3 to 6 months after the first surgery depending on the patient's occupation and sports activity.

Aside from the more common dorsal avulsion fractures, isolated triquetral body fractures are a rare injury and often missed. When they are identified, conservative treatment via immobilization is often the standard of care for initial treatment. Rarely, triquetral body fractures can develop into symptomatic nonunions, causing considerable pain and disability. Multiple classification schemes have been described to categorize triquetrum fractures; however, distal triquetrum fractures fit into none of the established models. There is scarce literature describing treatment of triquetral body fracture nonunions. The few reports that exist often use a variation of open reduction internal fixation with or without grafting as treatment. We present the case of an unusual triquetral body fracture nonunion that was successfully treated via surgical excision of the ununited distal fragment.

Ulnar impaction syndrome, also called ulnocarpal abutment syndrome, is one of the most common causes of ulnar-sided wrist pain in the presence of a normal or positive variance of the distal ulnar head. Usually, it is associated with degeneration of the triangular fibrocartilage complex. This condition is commonly treated by debridement of the central part of the triangular fibrocartilage complex ligament followed by a wafer resection of the ulnar head. Alternative surgeries are wafer resection preserving an intact triangular fibrocartilage complex ligament and an inverted wafer resection corresponding to a lunate and triquetrum proximal resection with luno-triquetral ligament debridement.

The pisiform bone forms a mobile articulation with the triquetrum that is stabilized by several ligaments and flexor carpi ulnaris tendon. The inherent mobility predisposes the joint to instability and wear and results in ulnar-sided wrist pain. Arthroscopy of the PTJ is a minimally invasive approach to evaluation and treatment of PTJ pain and results in predictable outcomes and early return to sports. This chapter describes a safe approach to the pisotriquetral articulation using standard portals and various therapeutic techniques are presented.

The treatment choice in scapholunate (SL) injury depends on the extent of the SL ligament tear, chronicity of injury, quality of the ligament remnants, reducibility of carpal malalignment, and cartilage status of the radiocarpal and midcarpal joints. In the absence of degenerative changes with chronic reducible dissociation, the optimal treatment would be the reconstruction of the SL interosseous ligament. Various SL reconstruction techniques via open or arthroscopic approaches have been described over the years; they include tendon reconstructions, volar/dorsal capsulodesis, SL allografts, bone-tissue-bone composite grafts, reduction and association of the scaphoid and lunate procedure, SL axis method, and SL internal brace technique. However, all of these techniques have their own shortcomings and disadvantages. The present study demonstrates a new technique using a suture-button device for the reduction and fixation of SL diastasis. The suture-button system is positioned between the scaphoid and the triquetrum, the direction of the system prevents scaphoid flexion and maintains continuity of the reduction. Arthroscopic dorsal ligamento-capsulodesis technique can be added to achieve biological healing during the stabilization process. The major advantages of this technique over others are a straightforward application with shorter operative time and lack of a need for harvesting a tendon graft. The technique is performed through mini-incisions, which enable a shorter postoperative recovery time and rehabilitation period and a quicker restoration of function which decreases the risk of joint stiffness. Furthermore, large bone tunnels which increase the risk of fracture are avoided.

Background Open or arthroscopic partial resection of the elongated ulnar styloid is the surgical treatment of choice for ulnar styloid impaction syndrome. Case Description A patient with a severely elongated processus styloideus ulnae (PSU) with a chronic impaction of the distal-radial margin against the triquetrum suffered a traumatic triangular fibrocartilage complex (TFCC) Palmer 1B rupture and DRUJ instability. The length of the PSU was 9 mm. After failed conservative treatment, a partial oblique arthroscopic resection of the PSU and simultaneous TFCC reinsertion were performed with uneventful recovery. Literature Review Arthroscopic resection has emerged as an alternative to the traditional open PSU resection for the treatment of styloid impaction syndrome. A transverse resection is described as the treatment of choice. Regarding the extent of resection subtotal ligament sparing resection or resection to the lower margin have been suggested. Clinical Relevance Surgical planning of PSU resection should take into consideration the anatomy of the impingement. The extent of resection should be planned individually, and sometimes an oblique resection may be the preferred option.

Background There continues to be controversy regarding the treatment of early-stage arthritis of the wrist, particularly in young patients, because of the large number of techniques, the poor long-term results for many of these techniques, and the overall paucity of high-level scientific data. Proximal row carpectomy (PRC) and 4-corner arthrodesis (4CA) have been established as the mainstay motion-sparing surgical treatment options in cases of early scapholunate advanced collapse and scaphoid nonunion advanced collapse arthritis. However, there is marked controversy surrounding the best treatment option for younger patients with greater physical demands because of the questionable outcomes associated with these motion-sparing options in such patients1-9. Traditionally, many surgeons prefer 4CA over PRC for young, high-demand patients, in part because studies have suggested that young age and work status as a laborer are important risk factors for worse outcomes following PRC1,8. However, the concern for symptomatic nonunion and potential for radiolunate arthritis in 4CA, as well as the lack of medium to long-term comparative studies in this subset, make this recommendation controversial10. Description The wrist is accessed via the dorsal approach, creating a retinacular flap and a radially based ligament-sparing capsulotomy. The scaphoid, lunate, and triquetrum are then excised en bloc. The radioscapholunate ligament is protected. The capsule and retinaculum and then repaired. Alternatives Alternatives to PRC include nonoperative treatment, 4CA, capitolunate arthrodesis, posterior and anterior interosseous neurectomies, total wrist arthroplasty, and total wrist arthrodesis. Rationale A recent study by Wagner et al. compared patients

Introduction: The wrist is a common site for work-related musculoskeletal disorders (WMSD) among physical therapists (PTs), often due to manual therapy. There are limited data on management of wrist injury in PTs. The purpose of this case is to describe the management of a PT with wrist pain.Case Description: The patient was a 28-year-old female with a 6-month history of right ulnar-sided wrist pain, aggravated by performing thoracic/lumbar posterior to anterior (PA) glides. The patient reported 7/10 on the Numeric Pain Rating Scale and 6.5/10 on the Patient-Specific Functional Scale (PSFS). Symptoms were reproduced at the lunotriquetral joint.Outcomes: The patient was seen for two visits. Following anterior to posterior non-thrust mobilization at the triquetrum on lunate, the patient improved inability to perform thoracic/lumbar PA glides. The patient was educated on manual therapy modifications, isometrics, and self-mobilization. At 2-month follow-up, the patient reported 0/10 pain, scored 10/10 on the PSFS, and +7 on the Global Rating of Change.Discussion: This case demonstrates the successful use of education, manual therapy, and exercise in the management of a PT with a wrist-related WMSD. Future research should focus on the prevention/treatment of wrist-related WMSDs in PTs who perform manual therapy.

Diagnosis and proper initial management of acute fractures of the carpal bones is critical because of the limited blood supply of many bones of the wrist and the role of the carpus in optimizing hand function. Pathology is correctly diagnosed by a focused history and examination. Injuries may be missed with a cursory examination and routine wrist radiographs. Together, fractures of the scaphoid and triquetrum make up nearly 90% of carpal bone fractures. Relative frequency, mechanism of injury, diagnosis, and management principles are covered for each of the bones of the wrist.

Objective To evaluate the outcomes of scaphoidectomy and capitolunate arthrodesis versus four-corner arthrodesis in patients with stage III scaphoid nonunion advanced collapse (SNAC) wrists. Methods We reviewed retrospectively all of the consecutive patients surgically treated in our center between 2007 and 2015, including 20 patients in the four-corner arthrodesis group and 11 patients in the capitolunate group. The mean follow-up time was of 47 months. The follow-up evaluation included wrist range of motion (ROM), grip strength, visual analogue scale (VAS), the disabilities of the arm, shoulder, and hand (DASH) questionnaire, and the Mayo wrist scale (MWS). Postoperative complications and the radiographic evaluation were also assessed. Results There was no statistical difference in flexion, radial deviation, ulnar deviation, grip strength, VAS, DASH or MWS scores. There was a statistically significant increase (6°) in extension in capitolunate arthrodesis versus four-corner arthrodesis, possibly without clinical relevance. There were two nonunions in the four-corner group, and none in the capitolunate group. None of the patients in the capitolunate group required screw removal. One patient in the four-corner group required dorsal plate removal. One patient in each group required conversion to total arthrodesis. Conclusions Capitolunate arthrodesis shows similar results in wrist ROM, grip strength and patient-reported outcomes when compared with four-corner arthrodesis at an average follow-up period of 4 years. We did not have any pisotriquetral arthritis in the capitolunate arthrodesis group, despite not removing the triquetrum in any of patients of this group. Type of study/level of evidence Therapeutic III.

Background Reverse perilunate injuries are rare. Contrary to perilunate injuries, the violent force would start from the lunotriquetral ligament, go reversely toward the radial side, and cause the reverse or ulnar-sided perilunate dislocation. Case Description We describe a 31-year-old man with a reverse perilunate dislocation, who presented to our institution 3 weeks after a motorcycle accident. The patient was successfully treated with the reduction and association of the lunate and triquetrum (RALT) procedure by using closed maneuver and percutaneous headless compression screw fixation. The patient can obtain a good radiographic result and satisfactory function at the 30-month follow-up. Literature Review Many case series were reported concerning the perilunate injuries. However, few cases of reverse perilunate dislocation have been reported in the literature. No cases of reverse perilunate dislocation treated 3 weeks after the injury with the RALT procedure have been reported. Clinical Relevance In this case, we found that the dislocation could still be reduced with the closed maneuver. With the RALT procedure, the carpal alignment can be maintained and the stability can be regained. Also, the functional outcomes are good.

Ulnar-sided wrist pain at the dorsal proximal triquetrum, especially during wrist pronation, flexion and radial deviation, is common in athletes, particularly ice hockey players. The purpose of this study was to evaluate in which position the dorsal ulnotriquetral ligament (DUTL) is placed under the greatest strain, the torque to failure and the injury pattern. We hypothesized that the DUTL is maximally strained with wrist flexion, pronation and radial deviation, and that, at failure, the ligament tears off the triquetrum.We performed a biomechanical study on 7 fresh frozen cadaveric upper extremities, with testing done on a wrist-movement stimulator to identify the position (45° of wrist flexion, 45° of wrist extension or neutral) that generated the highest and earliest strain increases in the DUTL. We performed load-to-failure testing, characterized the ligament's pattern of failure, and repaired and retested the DUTL using the same load-to-failure protocol.The DUTL reached 3 N∙m the earliest in 45° of wrist flexion (This study showed a reproducible pattern of injury to the DUTL in a cadaveric model. Additional work is needed to further characterize the pathoanatomy of "hockey wrist."La douleur cubitale au poignet, au niveau du triquetrum proximal dorsal, surtout à la pronation, à la flexion et à la déviation radiale du poignet, est fréquente chez les athlètes, particulièrement chez les joueurs de hockey. Le but de cette étude était d'évaluer la position dans laquelle le ligament ulnotriquétral dorsal (LUTD) est soumis à la pression la plus grande, le couple de torsion menant à la défaillance et le mode de blessure. Selon notre hypothèse, le LUTD est soumis au maximum de pression lorsque le poignet est en flexion, pronation et déviation radiale, et au moment de la défaillance, le ligament ulnotriquétral se déchire.Nous avons procédé à une étude biomécanique sur 7 membres supérieurs de cadavres frais congelés, et effectué des tests sur un stimulateur de mouvements du poignet pour établir la position (flexion du poignet à 45°, extension du poignet de 45° ou position neutre) générant les augmentations de pression les plus fortes et les plus rapides sur le LUTD. Nous avons procédé à des tests de mise en charge jusqu'à défaillance, caractérisé le mode de défaillance du ligament et réparé et retesté le LUTD à l'aide du même protocole de mise en charge jusqu'à défaillance.Le LUTD a atteint 3 N∙m le plus rapidement avec une flexion du poignet à 45° (L'étude a démontré un mode reproductible de lésion du LUTD à l'aide d'un modèle cadavérique. Il faudra approfondir la recherche pour caractériser avec plus de précision l'anatomopathologie de la lésion au poignet typiquement causée par la pratique du hockey.

Tenosynovial chondromatosis (TC) is a rare progressive benign tumor from the synovial lining of tendon sheath. The TC mostly affects males between the ages 30 to 50 years old at the ventral side of wrist. There are two different forms of TC that have been proposed in previous studies: an idiopathic cause (primary TC) and a joint related diseases cause (secondary TC). Even though trauma has been written to be a common reason for TC, a case of a secondary TC affecting the dorsal wrist following a triquetrum fracture has never been written before. The aim of this report is to present a rare case of a solitary post-traumatic TC at the dorsal wrist following a triquetrum fracture. We describe the clinical presentation, imaging modalities, histopathological and treatment challenges to manage this difficult lesion.