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Triquetral bone
Triquetral bone
Triquetral bone
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Triquetral bone
Left hand anterior view (palmar view). Triquetral bone shown in red.
The left triquetal bone
Details
ArticulationsArticulates with three bones:
lunate laterally
pisiform in front
hamate distally
triangular articular disk which separates it from the lower end of the ulna.
Identifiers
Latinos triquetrum, os pyramidale
MeSHD051221
TA98A02.4.08.006
TA21253
FMA23715
Anatomical terms of bone

The triquetral bone (/traɪˈkwɛtrəl, -ˈkwiː-/; also called triquetrum, pyramidal, three-faced, and formerly cuneiform bone) is located in the wrist on the medial side of the proximal row of the carpus between the lunate and pisiform bones. It is on the ulnar side of the hand, but does not directly articulate with the ulna. Instead, it is connected to and articulates with the ulna through the Triangular fibrocartilage disc[1] and ligament, which forms part of the ulnocarpal joint capsule.[2] It connects with the pisiform, hamate, and lunate bones. It is the 2nd most commonly fractured carpal bone.

Structure

[edit]

The triquetral is one of the eight carpal bones of the hand. It is a three-faced bone found within the proximal row of carpal bones. Situated beneath the pisiform, it is one of the carpal bones that form the carpal arch, within which lies the carpal tunnel. [3]: 708 

The triquetral bone may be distinguished by its pyramidal shape, and by an oval isolated facet for articulation with the pisiform bone. It is situated at the upper and ulnar side of the carpus. To facilitate its palpation in an exam, the hand must be radially deviated so that the triquetrium moves out from under the ulnar styloid process. The triquetrum may be difficult to find, since it also lies under the pisiform.

The triquetral bone has nutrient foramina for entering the nutrient vessels into the bone which comes from branches of the radial, ulnar, and interosseous arteries.[4]

Ossification

[edit]

The triquetral bone ossifies between 9 months and 50 months (4 years and 2 months).[5]

Surfaces

[edit]

The superior surface presents a medial, rough, non-articular portion, and a lateral convex articular portion which articulates with the triangular articular disk of the wrist.

The inferior surface, directed lateralward, is concave, sinuously curved, and smooth for articulation with the hamate. The dorsal surface is rough for the attachment of ligaments.

The volar surface presents, on its medial part, an oval facet, for articulation with the pisiform; its lateral part is rough for ligamentous attachment.

The lateral surface, the base of the pyramid, is marked by a flat, quadrilateral facet, for articulation with the lunate.

The medial surface, the summit of the pyramid, is pointed and roughened, for the attachment of the ulnar collateral ligament of the wrist.

In animals

[edit]

In reptiles and amphibians, the bone is instead referred to as the ulnare, since (at least in the most primitive fossils) it articulates with the ulna.

Function

[edit]

The carpal bones function as a unit to provide a bony superstructure for the hand.[3] : 708 

Fracture

[edit]

Triquetral fractures can occur due to forceful flexion of the wrist, causing an avulsion of the dorsal aspect of the bone that is often hidden on anterior radiographs, but can be seen as a tiny bone fragment on lateral views.

Etymology

[edit]

The etymology derives from the Latin triquetrus which means "three-cornered." Therefore, it is sometimes also called the triangular bone or os triangulare. However, os triangulare may also refer to a nearby accessory bone.

Additional images

[edit]
  • Triquetral bone of the left hand (shown in red). Animation.
    Triquetral bone of the left hand (shown in red). Animation.
  • Triquetral bone of the left hand. Close up. Animation.
    Triquetral bone of the left hand. Close up. Animation.
  • Triquetral bone.
    Triquetral bone.
  • Right hand posterior view (dorsal view). Thumb on bottom.
    Right hand posterior view (dorsal view). Thumb on bottom.
  • Right hand anterior view (palmar view). Thumb on top.
    Right hand anterior view (palmar view). Thumb on top.
  • Bones of the left hand. Palmar surface. Triquetral shown in yellow.
    Bones of the left hand. Palmar surface. Triquetral shown in yellow.
  • Bones of the left hand. Dorsal surface. Triquetral shown in yellow.
    Bones of the left hand. Dorsal surface. Triquetral shown in yellow.
  • Cross section of wrist (thumb on left). Triquetral shown in red.
    Cross section of wrist (thumb on left). Triquetral shown in red.
  • Triquetral fracture indicated by the white arrow.
    Triquetral fracture indicated by the white arrow.
  • Triquetral fracture as seen on lateral view of a radiograph.
    Triquetral fracture as seen on lateral view of a radiograph.

References

[edit]

See also

[edit]
Wikimedia Commons has media related to Triquetral bone.
This article uses anatomical terminology.
Revisions and contributorsEdit on WikipediaRead on Wikipedia

Triquetral bone

View on Grokipedia
from Grokipedia
The triquetral bone, also known as the triquetrum, is a pyramidal carpal bone located in the proximal row of the wrist on the ulnar (medial) side, positioned between the lunate bone laterally and the pisiform bone volarly. It articulates with three adjacent bones—the lunate via a flat facet on its radial surface, the pisiform via an oval facet on its volar surface, and the hamate via a concave facet on its distal surface—while also connecting to the triangular fibrocartilage complex (TFCC) proximally. This pyramidal structure, with its base proximally and apex pointing distally and medially, forms part of the transverse carpal arch and contributes to the overall skeletal framework of the wrist. Anatomically, the triquetrum features non-articular surfaces that serve as attachment sites for several ligaments, including extrinsic ligaments such as the dorsal and volar radiotriquetral, ulnotriquetral, and radiolunotriquetral ligaments (part of the TFCC), as well as intrinsic ligaments like the scaphotriquetral, lunotriquetral, triquetrohamate, and triquetrocapitate. Its blood supply arises from nutrient arteries entering through foramina on the non-articular surfaces, forming intraosseous anastomoses that supply the bone via branches of the , ulnar, and anterior interosseous arteries, which helps minimize the risk of . The bone's innervation is indirect, as part of the joint complex, primarily from the anterior interosseous branch of the and the posterior interosseous branch of the . Functionally, the triquetrum plays a key role in stability and motion, participating in both radiocarpal and midcarpal movements, including flexion, extension, abduction, and adduction, while supporting the passage of neurovascular structures and tendons through the . It helps maintain the transverse arch of the carpus, which is essential for hand dexterity and load transmission during gripping or weight-bearing activities. Clinically, the triquetrum is the second most common site of carpal bone fractures after the scaphoid, often resulting from falls on an outstretched hand causing dorsal impaction or ligamentous avulsions, with tenderness at the "triquetral point" on the ulnar dorsal wrist as a hallmark sign. Congenital variations, such as absence or fusion with the lunate (lunotriquetral ), occur but are rare, and the bone's robust vascularity generally supports good healing outcomes with conservative management for most injuries.

Anatomy

Location and relations

The triquetral bone, also known as the triquetrum, is situated in the proximal row of the within the , positioned on the medial or ulnar side. It lies between the lunate bone radially and the palmarly, forming the third bone in the sequence from radial to ulnar: scaphoid, lunate, triquetrum, and pisiform. The triquetral bone relates distally to the in the distal carpal row and ulnarly to the complex (TFCC), which separates it from direct articulation with the ; instead, it contributes to stability through indirect connections via the TFCC and associated ligaments. The bone is pyramidal in shape, with its base on the and apex directed ulnarly, and measures approximately 14-22 mm in length (mean 17 mm), reflecting its compact role in the wrist's architecture. As part of the carpal arch, the triquetral bone helps form the floor of the by providing a medial attachment point for the flexor retinaculum, alongside the hamate, thereby enclosing the flexor tendons and .

Surfaces and articulations

The triquetrum bone exhibits a pyramidal morphology, with its base on the and apex directed ulnarly, facilitating its integration into the wrist's architecture. This shape positions the bone medially in the proximal carpal row, adjacent to the lunate and pisiform. The triquetrum features three primary articular surfaces that enable its connections within the . The lateral surface presents a flat, facet that articulates with the lunate bone, allowing for intercarpal motions due to its relatively planar . The distal surface is concave and sinuously curved, forming an articulation with the that supports smooth proximal-distal interactions. On the palmar surface, a small facet provides the interface for articulation with the , contributing to the pisotriquetral . In contrast, the dorsal surface is rough and non-articular, serving primarily as an attachment site for ligaments rather than direct formation. The borders of the triquetrum further define its articulations and attachments. The medial (ulnar) border is pointed and rough, anchoring the triangular fibrocartilage complex (TFCC) and the , which stabilize the ulnar side of the . The proximal aspect includes a convex lateral facet that interfaces with the TFCC, while the distal facet's curvature accommodates gliding with the hamate. Ligamentous attachments are prominent: the dorsal radiocarpal ligament inserts on the dorsal surface, the pisotriquetral ligament spans the palmar articulation with the pisiform, and the reinforces the medial border. These features collectively ensure the triquetrum's role in stability and mobility.

Development

Ossification

The triquetral bone develops through , a in which bone tissue replaces a pre-existing cartilaginous model that is present at birth. This cartilaginous precursor lacks any initially, with the bone remaining entirely cartilaginous during the fetal and early postnatal periods. A single primary emerges postnatally, marking the onset of bone formation within the . This center typically appears between 2 and 3 years of age, though radiographic studies indicate a variability ranging from as early as 6-8 months in approximately 20% of cases to full by 4.5-5.5 years in all individuals. The primary of the triquetral bone generally precedes that of the adjacent lunate bone, with the triquetral often visible by the third year of life while the lunate follows in the fourth year. Once initiated, proceeds radially from this single center, gradually replacing the surrounding . Fusion between the expanding and the remaining cartilaginous framework completes during late childhood, typically by 6 to 7 years of age, resulting in a fully ossified triquetral bone that adopts its characteristic pyramidal shape. The triquetral bone features no secondary ossification centers, distinguishing it from many long bones that develop multiple sites for growth. Postnatal maturation and shaping of the bone are primarily driven by mechanical stresses arising from early usage and loading, which influence the rate and pattern of endochondral bone formation. Variations in the timing of triquetral can occur, particularly in premature infants, where overall skeletal maturation is often delayed due to incomplete gestational development. Certain genetic conditions, such as and trisomy 21, are also associated with postponed appearance of carpal ossification centers, including the triquetral, reflecting broader disruptions in advancement.

Vascular supply

The vascular supply of the triquetral bone is derived from branches of the radial and ulnar arteries, including their dorsal and palmar carpal branches, as well as contributions from the anterior interosseous artery, which collectively form a network of vessels entering through non-articular surfaces. These arteries provide robust to the bone, supporting its metabolic needs and minimizing the risk of ischemia compared to other with more singular dependencies. Nutrient foramina are predominantly located on the dorsal surface, with an average of 2.97 ± 1.28 foramina per (range 3-12), though palmar foramina are also present, typically proximal to the pisiform articulation; the dorsal aspect accounts for approximately 72% of vessel entries, indicating a stronger vascular dominance from that side. Intraosseous anastomoses connect these vessels in roughly 57% of cases, allowing for collateral circulation between dorsal and palmar networks to enhance overall stability of the blood flow. This multi-source intraosseous vascular pattern, characterized by multiple entry points and interconnections, contributes to the 's resilience against . The vascular pathways are accompanied by sensory branches of the , which provide innervation to the and surrounding soft tissues, offering proprioceptive and nociceptive feedback integrated with the nutritive supply. During development, this vascular network supports by enabling early ingrowth of vessels essential for remodeling and bone maturation.

Function

Role in wrist movement

The triquetral bone plays a key role in facilitating ulnar deviation and flexion through its gliding articulations with the adjacent lunate and hamate bones. During ulnar deviation, the triquetrum translates distally by approximately 3.7 mm and volarly by 2.6 mm relative to the hamate, enabling smooth midcarpal motion as part of the overall kinematics. Similarly, in coordination with the lunate within the proximal carpal row, the triquetrum undergoes coupled flexion and extension during radial-ulnar deviation, contributing to the proximal row's adaptive response to these movements. As a component of the proximal carpal row, the triquetrum is essential to the dart-throwing motion, an oblique plane of activity that integrates radial-ulnar deviation with flexion-extension and is critical for functional tasks like or tool use. Kinematic studies demonstrate that the proximal row, including the triquetrum, remains nearly stationary during this motion, with minimal rotation and translation to provide a stable base while the distal row accommodates the primary arc from radial extension to ulnar flexion. This relative stability enhances control and precision in the dart-throwing plane, which represents one of the most functional and kinematically efficient paths of wrist motion. The triquetrum contributes to overall wrist motion through its articular facets, with kinematic studies showing the bone undergoes up to approximately 25° of flexion and 30° of extension during wrist flexion-extension movements, supporting the bone's role in distributing forces across the radiocarpal and midcarpal joints. Additionally, through its interaction with the pisiform at the pisotriquetral joint, where the pisiform acts as a fulcrum, the triquetrum enables subtle gliding motions that aid in fine hand movements and transmit forces from forearm muscles like the flexor carpi ulnaris across the wrist.

Contribution to hand stability

The triquetrum serves as a key stabilizer within the proximal carpal row, facilitating the transmission of compressive and shear forces from the through the midcarpal joint to the metacarpals via its articulation with the hamate. This linkage ensures efficient load distribution across the ulnar column during activities, maintaining overall carpal alignment under physiologic stresses. The triquetrum integrates closely with the triangular fibrocartilage complex (TFCC), particularly through attachments to the ulnocarpal ligaments, to resist ulnar translocation of the carpus during axial loading. Disruption of these connections can lead to excessive ulnar deviation of the proximal row, compromising integrity. This stabilizing function is essential for countering translational forces that arise in dynamic hand positions. Ligamentous reinforcements, including the ulnotriquetral and ulnolunate components of the ulnocarpal ligament complex, anchor the triquetrum firmly to the and , enabling the distribution of compressive forces across the ulnar . The TFCC, in conjunction with these ligaments, transmits approximately 20% of axial loads from the carpus to the distal , buffering impacts that may exceed body weight in high-force scenarios. As part of the proximal ulnar border of the carpal arch, the triquetrum contributes to the structural maintenance of the , helping to contain and protect the and flexor tendons within the confined space.

Clinical significance

Fractures

Triquetral fractures are the second most common carpal fractures after those of the scaphoid, with reported incidences ranging from 3% to 28% of all carpal bone injuries, depending on the study population. These fractures often result from the bone's ulnar position, which exposes it to shear and impaction forces during trauma. The primary types include dorsal cortical avulsion fractures, which comprise 93% to 95% of cases and typically involve a small fragment from the dorsal ridge; triquetral body fractures, which are less frequent and often associated with perilunate injuries; and volar lip or cortical fractures, the rarest type, usually from avulsion of palmar ligaments. Common mechanisms involve a fall on an outstretched hand (FOOSH) with the wrist in extension and ulnar deviation, leading to impaction against the ulnar styloid or hamate, or direct dorsal trauma; dorsal avulsions specifically arise from tension on the dorsal radiotriquetral or scaphotriquetral ligaments. Diagnosis begins with clinical evaluation revealing ulnar-sided wrist pain, tenderness over the dorsal triquetrum, and swelling exacerbated by flexion or extension. starts with plain radiographs, where a lateral view may show the "pooping duck" —an avulsed dorsal fragment resembling a protrusion from the triquetrum's outline formed by adjacent ; oblique or pronated views help detect body or volar fractures, while computed (CT) is recommended for occult or complex cases. Most triquetral fractures are managed conservatively with immobilization in a short or splint for 4 to 6 weeks, yielding good outcomes in nondisplaced cases with pain resolution in about 86% of patients. Displaced fractures, particularly those involving the body or associated , require surgical intervention such as open reduction and with screws or Kirschner wires. Complications are uncommon but may include , which is rare due to the bone's robust , or persistent necessitating fragment excision in symptomatic avulsions.

Associated conditions

The triquetral bone is implicated in several non-fracture pathologies, primarily degenerative and inflammatory conditions affecting the ulnar . Pisotriquetral osteoarthritis, involving the articulation between the pisiform and triquetral bones, arises from repetitive stress, such as in manual laborers or athletes, or from prior trauma leading to joint degeneration. This condition manifests as chronic ulnar-sided wrist pain, exacerbated by grip or pressure over the pisiform, and may include swelling or on . Radiographic findings often reveal joint space narrowing, subchondral sclerosis, and formation, with prevalence increasing in older populations. Avascular necrosis of the triquetral bone, though rare and distinct from the more common Kienböck disease of the lunate, results from disrupted vascular supply to the bone, potentially leading to subchondral collapse and cystic changes. Risk factors include long-term use, which impairs blood flow, as well as systemic conditions like or excessive alcohol consumption. Symptoms typically involve insidious ulnar pain and reduced , with MRI demonstrating and low-signal necrotic areas on T1-weighted images. Prior fractures may predispose the triquetral to this condition by further compromising its retrograde blood supply. In ulnar impaction syndrome, the triquetral bone experiences secondary loading due to ulnar head abutment against the triangular fibrocartilage complex (TFCC), causing chondromalacia and subchondral changes in the ulnar carpals. This degenerative process is often linked to positive ulnar variance and repetitive axial loading, resulting in ulnar pain worsened by or deviation. Diagnostic MRI reveals TFCC tears, lunate and triquetral bone marrow edema, and subchondral cysts, confirming the impaction's impact on triquetral integrity. Ganglion cysts originating near the triquetral bone, particularly in the dorsal or volar wrist, can arise from joint capsule degeneration or underlying ligamentous pathology, compressing adjacent structures and causing localized pain or weakness. Ligamentous instability, such as lunotriquetral (LT) ligament tears, disrupts triquetral alignment, leading to volar intercalated segment instability (VISI) and dynamic carpal malalignment. These tears often stem from acute hyperextension or chronic repetitive strain, with associated ganglion cysts noted in imaging as fluid-filled masses linked to ligament disruption. Symptoms include clicking sensations and pain during wrist motion, best evaluated via arthrography or dynamic MRI to assess triquetral subluxation.

Nomenclature and comparative aspects

Etymology

The term "triquetral bone" derives from the Latin word triquetrus, meaning "three-cornered" or "triangular," a reference to the bone's distinctive pyramidal shape featuring three prominent articular facets. This nomenclature highlights the bone's morphology, with its wedge-like form and three-sided appearance distinguishing it among the carpal bones of the wrist. The , including the triquetral, were first systematically described in modern anatomical literature during the , notably by in his seminal work De Humani Corporis Fabrica (1543), where he illustrated and discussed their structure without yet employing the precise Latin terms that would later standardize . Earlier medieval texts occasionally referred to similar bones using descriptive Latin phrases, but the specific evolution toward "triquetral" solidified in subsequent centuries as anatomical precision advanced. Historically, the bone was known as the "" bone—evoking its wedge shape—following its naming by anatomist Johann Lyser in 1653, a term that led to confusion with tarsal bones of the foot. It was not until 1726 that Bernhard Siegfried Albinus formally adopted "triquetrum" as the preferred designation, aligning it more accurately with its trihedral geometry and establishing the enduring etymological foundation in . This shift reflects broader trends in 17th- and 18th-century toward shape-based Latin descriptors for skeletal elements.

In non-human animals

In reptiles and amphibians, the triquetral bone is homologous to the ulnare, a proximal carpal element that articulates directly with the to facilitate primitive wrist flexion and extension, enabling independent movement of the and during locomotion. This configuration supports basic terrestrial and aquatic maneuvers, with the ulnare often positioned medially in the carpus to stabilize the against the . Among mammals, the triquetral retains a similar pyramidal shape to that in humans but exhibits variations tied to locomotor demands; in such as baboons (Papio spp.), it is proportionally larger relative to body size, featuring a proximodistally elongated and mediolaterally narrow form with a concave ulnar facet, adaptations that enhance stability during quadrupedal and semi-arboreal locomotion. In contrast, quadrupedal mammals like (Equus caballus) integrate the triquetral (as the ulnar carpal bone) into a more fused carpal complex, where proximal row elements form a rigid block with the and to distribute weight and absorb shock at high speeds, reducing individual bone mobility for efficient galloping. Evolutionarily, the triquetral shows reduced direct ulnar articulation in compared to other mammals, with the receding to form a styloid process and a neomorphic , allowing greater mobility for suspensory and manipulative behaviors while the triquetral maintains contact via a meniscus-like structure. In , this fusion into a carpal block further emphasizes speed over flexibility, reflecting adaptations to lifestyles. The triquetral is absent or rudimentary in fish lineages, where pectoral fin skeletons lack distinct carpal homologs and instead feature simple radials or lepidotrichia derived from dermal elements, marking the evolutionary origin of segmented autopods in early tetrapods.

References

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