1. Imaging Findings

Based on the provided wrist X-ray, there appears to be a bony discontinuity or avulsion-type fragment on the dorsal aspect of the triquetrum, suggesting a possible triquetrum fracture. The fracture site on the dorsal side shows a small, irregular fragment of bone with altered density compared to the surrounding bone. No obvious fracture signs are noted in the adjacent carpal bones (e.g., lunate, pisiform), but further evaluation is recommended to accurately determine the extent of the fracture and to assess any soft tissue swelling or swelling shadows.

2. Potential Diagnoses

1. Triquetrum Fracture: Commonly occurs in falls where the wrist is in dorsiflexion and ulnar deviation, or due to direct impact (e.g., boxing or a fall) to the dorsal aspect of the wrist, causing an avulsion or compression fracture on the dorsal side of the triquetrum. Clinical features are consistent with the imaging findings.
2. Lunate Fracture: The lunate is adjacent to the triquetrum and can present with similar imaging features. However, lunate fractures often occur with other carpal fractures or dislocations. The current image primarily shows triquetrum involvement, supporting a diagnosis of triquetrum fracture.
3. Other Carpal Injuries: Given that hand trauma can frequently result in multiple fractures or ligament injuries, it is important to assess the overall integrity of the wrist joint. However, the images mainly indicate involvement of the triquetrum, with no evident fractures in other carpal bones.

3. Final Diagnosis

Taking into account the patient’s age (21 years), history of injury (fall or direct impact), and imaging findings (a dorsal bony fragment or cortical discontinuity in the triquetrum), the most likely diagnosis is a triquetrum fracture.

4. Treatment Plan and Rehabilitation

1. Treatment Strategy:

1. Conservative Treatment: In cases without significant displacement, a cast or brace can be used to immobilize the wrist and limit motion, typically for 4–6 weeks. Regular follow-up and imaging studies are recommended during this period to assess healing progress.
2. Surgical Treatment: If there is notable displacement, joint surface collapse, or severe concomitant carpal injuries, surgical intervention (e.g., internal fixation or joint reconstruction) should be considered to ensure proper alignment and functional recovery.
3. Pharmacological Support: NSAIDs and other pain relievers can help reduce pain and local inflammation.

2. Rehabilitation and Exercise Prescription (FITT-VP Principle):

1. Immobilization Period (4–6 weeks):
   • Frequency (F): 1–2 times per day of basic exercises.
   • Intensity (I): Maintain a low level of activity, without causing significant pain.
   • Time (T): 5–10 minutes per session, focusing on maintaining range of motion and simple gripping movements.
   • Type (T): Perform basic finger movements and shoulder/elbow joint activities under protective immobilization, avoiding wrist loading.
   • Progression (P): Gradually increase finger movement and muscle strengthening as the fracture heals.
2. Cast Removal to Consolidation Phase:
   • Frequency: 3–4 times per week for targeted wrist function training.
   • Intensity: Progress to moderate intensity, including light resistance exercises.
   • Time: 15–20 minutes per session.
   • Type: Active wrist flexion/extension, pronation/supination exercises, grip strength training, and supportive physical therapy (heat, massage) to promote soft tissue recovery.
   • Progression: As pain and swelling reduce and strength returns, gradually incorporate elastic band exercises or light weight-bearing, transitioning toward normal daily activities.
3. Complete Functional Recovery:
   • Depending on the patient’s sport or work requirements, additional wrist agility and coordination training may be introduced, including wrist stabilization drills and light strength exercises.
   • For individuals who need frequent wrist movements at work or in sports, intensity should be increased gradually under professional guidance to avoid reinjury.

5. Disclaimer

This report is for reference purposes only and does not replace an in-person consultation or the advice of a medical professional. If you have any concerns or experience any discomfort, please seek medical attention and follow the treatment plan recommended by your specialist.