3-dimensional investigation of the vascular anatomy of the triquetrum with micro-computed tomography

This study aims to demonstrate the 3-dimensional pattern of the nutrient vessels of the triquetrum using micro-computed tomography and determine the safe region for screw applications to the bone.

Seven fresh frozen cadavers' ulnar and radial arteries were injected with Microfil MV-117. Triquetral bones were dissected and examined using micro-computed tomography. 3D modeling was conducted, recording the number of main artery branches entering the bone, their entry points, diameters, cross-sectional areas, and anastomoses. Based on the bone tunnel and screwing procedures applied to the bone, 3 axes were determined in the bone and the vessel volumes in these axes were calculated.

On average, 7.14 ± 4.18 vessels entered each bone, with 5.14 entering dorsally and 2 palmarly. The vessel volume in the dorsal region was significantly higher than in the palmar region (p < 0.05). The vessels in the dorsal region were significantly wider than those in the palmar region (p < 0.05). There were anastomoses between intraosseous vessels in 57 % of the bones. In all of the bones, vessels were detected at the attachment point of the lunotriquetral ligament.

The results of our study showed that the intraosseous blood supply of the triquetrum is rich, thus, complications such as avascular necrosis and nonunion have low incidence. In addition, since the lateral axis contains fewer intraosseous vessels, it is the most appropriate axis to be applied in screw and bone tunnel operations. Knowing the intraosseous blood supply pattern and the most appropriate axis for bone-invasive interventions of the triquetrum, which plays an important role in wrist biomechanics, may guide the surgeon when performing these procedures.