A Rare Case of Bilateral Lunotriquetral Coalition and Bilateral Scaphoid Nonunion

Abstract

To the Editor: Carpal coalition is rare in Caucasians, with a prevalence of 0.1%, but it is more prevalent in WestAfrican populations. Lunotriquetral (LT) coalitions are most common and can be classified into 4 Minnaar types. Type 1 includes a fibrocartilage coalition resembling pseudoarthrosis, type 2 is incomplete osseous fusion with a distal notch, type 3 is complete osseous fusion, and type 4 is complete fusion with other abnormalities. We wish to report a rare case of bilateral LT coalition with bilateral scaphoid nonunion, which to our knowledge has not been reported previously in the Englishliterature. A 16-year-old African boy playing American football presented with right-sided wrist pain 2 months after a fall. Radiographs showed no acute osseous pathology. Half a year later, the patient had a similar injury to the opposite wrist. After a delay of 3 months, he presented with persisting pain of both wrists. A bilateral computed tomography scan showed a bilateral scaphoid nonunion and left-sided Minnaar type 1 and right-sided Minnaar type 3 coalitions (Fig. 1). The left-sided nonunion was successfully treated with screw fixation. The right-sided nonunion was initially treated with screw fixation in conjunction with cancellous bone grafting. However, because of persistent nonunion and additional fracturing of the proximal pole postoperatively, a subsequent salvage procedure was performed including styloidectomy, proximal scaphoid excision, and pyrocarbon implant insertion (APSI; Tornier, Montbonnot-SaintMartin, France). Lunotriquetral coalition is often an asymptomatic and incidental finding. Some patients present with pain resulting from fracturing of the fused part of the joint after trauma. One French article evaluated 32 wrists