Unveiling the uncommon: a case report of avascular necrosis in the triquetrum bone without trauma

Abstract

Introduction and importance: Avascular necrosis (AVN) is a rare occurrence in the carpal region, especially in the triquetrum bone, which presents a diagnostic puzzle due to its infrequency and lack of trauma history. This case study explores the signs, diagnosis, and treatment of AVN in a healthy 22-year-old individual, emphasizing the need for early identification using suitable imaging methods. Case presentation: A 22-year-old patient complained of persistent wrist pain, specifically on the ulnar side, without any history of injury. Clinical examination revealed tenderness without signs of inflammation, with normal sensation and movement. Initial X-ray results were inconclusive, prompting further investigation with MRI, which showed a decrease in signal intensity in the triquetrum bone, leading to the diagnosis of AVN. Clinical discussion: The development of AVN involves compromised blood flow, often due to various factors. While AVN affecting carpal bones is uncommon, the triquetrum bone’s robust blood supply typically protects against such conditions. However, this case highlights an exceptional occurrence. Gelberman’s classification underscores the triquetrum’s vascular nature, explaining why AVN is rare in this bone. MRI plays a crucial role in detecting AVN, especially when symptoms do not align with X-ray findings. Conclusion: Avascular necrosis should be considered in carpal bones, even without a history of trauma, with a focus on MRI for early detection. Although AVN of the triquetrum is rare, this case underscores the importance of timely recognition and conservative management. Further research is necessary to establish optimal treatment strategies for this unusual presentation.