Lunotriquetral Coalition Research Articles

Dorsal Screw Osteosynthesis of a Scaphoid Nonunion associated with Congenital Scaphotrapezial and Lunotriquetral Coalitions: A Case Report

We present the case of a 24-year-old man who sustained a scaphoid fracture in the presence of congenital scaphotrapezial and lunotriquetral coalitions. As the fracture progressed to a nonunion, a screw osteosynthesis was performed. The altered biomechanics caused by the two coalitions necessitated a dorso-proximal surgical approach, and two screws were implanted to prevent rotational instability. The scaphoid fracture healed entirely.

The Radiographic Effects of Lunotriquetral Coalition on Scapholunate Articulation

Introduction: Radiographic widening in the scapholunate (SL) joint due to lunotriquetral (LT) coalition has historically been viewed as normal due to reported false positives of SL dissociation/widening in patients with LT coalition. Minimal further investigations have been reported on these findings. Methods: Scapholunate interval, angle, third CMC joint space, and ligamentous measurements on CT, MRI, and X-ray imaging were compared for those with and without LT coalition. A multilevel one-way ANOVA was used to analyze CT SL angle versus X-ray SL angle and was compared to the control group. These comparisons were also performed for SL intervals and repeated for MRI imaging versus X-ray imaging. A t-test was completed to compare volar and dorsal ligament widths measured on MRI for the lunotriquetral and normal groups. Results: On X-ray and CT, no difference was measured in SL interval, angle, and third CMC joint space between those with and without LT coalition, but SL angle was higher in those without LT coalition on CT. On MRI, no difference was measured in SL angle, but SL interval was smaller in those without LT coalition. SL interval compared to third CMC joint space was smaller for all cohorts on MRI and CT. Conclusions: X-ray, CT, and MRI imaging of SL interval widening was not seen above normal radiographic parameters in the setting of LT coalition. Therefore, radiographic parameters of SL dissociation/widening should not change with LT coalition. The third CMC joint space was smaller compared to the SL interval and should not alone be used for radiographic diagnosis of SL dissociation.

Carpal coalition revisited an a propos of 80 cases of LT coalition and a skewed literature view

Carpal coalition is a rare congenital entity, the Luno-Triquetral (LT) coalition having the highest incidence. Additionally, LT coalition is described in literature to be most often bilateral and being more common in females. The range of LT coalitions is wide, starting from simple

Bilateral lunotriquetral coalition: a dynamic four-dimensional computed tomography technical case report.

Lunotriquetral coalitions are the most common form of carpal coalition wherein the cartilage between the lunate and triquetrum ossification centers failed to undergo apoptosis. This technical case report examines the arthrokinematics of bilateral lunotriquetral coalitions with dissimilar Minnaar types in one participant with one asymptomatic wrist and one wrist with suspected distal radioulnar joint injury. Static and dynamic (four-dimensional) CT images during pronosupination were captured using a photon-counting detector CT scanner. Interosseous proximity distributions were calculated between the lunotriquetral coalition and adjacent bones in both wrists to quantify arthrokinematics. Interosseous proximity distributions at joints adjacent to the lunotriquetral coalition demonstrate differences in median and minimum interosseous proximities between the asymptomatic and injured wrists during resisted pronosupination. Altered kinematics from lunotriquetral coalitions may be a source of ulnar-sided wrist pain and discomfort, limiting the functional range of motion. This case report highlights potential alterations to wrist arthrokinematics in the setting of lunotriquetral coalitions and possible associations with ulnar-sided wrist pain, highlighting anatomy to examine in radiographic follow-up. Furthermore, this case report demonstrates the technical feasibility of four-dimensional CT using photon-counting detector technology in assessing arthrokinematics in the setting of variant wrist anatomy.

Lunotriquetral Coalition.

Lunotriquetral (LT) coalition is the most common carpal coalition. Four morphological types of LT coalition have been described. LT coalition is usually asymptomatic, but rarely a fibrocartilaginous type may cause ulnar wrist pain. We report a case of bilateral asymptomatic LT coalition that was seen incidentally on conventional radiography taken after a wrist injury. Conventional radiography is the first imaging technique to detect and classify this type of LT coalition. Magnetic resonance imaging is a useful tool to investigate possible associated pathology of the carpal joints, particularly if surgical treatment of a symptomatic patient is anticipated.

Arthroscopic Resection of Lunotriquetral Coalition

Carpal coalition is a rare condition caused by a failure in the process of apoptosis. It is often incidentally diagnosed and seldomly symptomatic. The lunotriquetral joint is the most commonly affected joint, accounting for 90% of carpal coalitions. Minnaar classified the lunotriquetral coalitions into 4 types based on their type, extent, and associated abnormalities. Accurately classifying the coalition requires advanced imaging, and we show an example that includes 2-dimensional and 4-dimensional computed tomography and magnetic resonance imaging. Management of carpal coalitions include nonoperative and operative management. Splinting, anti-inflammatory drugs, hand therapy, activity modification, and steroid injections are all examples of nonoperative management. Operative management of coalitions in the carpus has historically been an arthrodesis whereas in the tarsal bones the gold standard is resection. Arthrodesis has a high complication rate and reduces wrist range of motion, whereas resection retains range of motion and allows the patient to return to activity sooner. We present 2 techniques of treating symptomatic carpal lunotriquetral coalition with arthroscopic resection.

Case report: Co-existent of lunotriquetral coalition with pisiform-hook of hamate coalition in the same wrist joint: An incidental radiographic finding

Fusion of carpal bones a rare and it is extremely rare to have ipsilateral lunotriquetral coalition, pisiform hamate coalition. In this report, we present a case of a 20-year-old male, with an incidental finding of ipsilateral lunotriquetral coalition, pisiform hamate coalition after a fall on outstretched hand. In such cases if a patient is not complaining of any persistent symptoms, we prefer to treat conservatively with no requirement of operative intervention. It is important to be aware of such anomaly to be part of you differential diagnosing and not to mistaken it for other unrelated abnormalities.

Asymptomatic bilateral luno-triquetral coalition a rare case report

Luno triquetral coalition is a congenital carpal anomaly that is most often diagnosed as an incidental finding and are usually asymptomatic. Here in this case report we present a 27-year-old male patient with the complaints of swelling and pain in left middle finger at middle interphalangeal (MIP) joint following a fall on outstretched hand. Keywords: Lunotriquetral coalition, Carpal coalition, Minnar

Carpal Coalition: Is It Really Rare and Incidental Finding?

Objectives: Carpal coalition (CC) defines the combined development of two or more carpal bones. The diagnosis is often made incidentally by the radiographs. Incidence of CC changes with ethnicity. CC may cause various symptoms because of the coalition type and the affected bones. We aim to analyze the incidence of CC, affected bones, define the symptoms and find out the correlation between CC, demographic factors and associated hand anomalies. Methods: A total of 9457 hand and wrist AP radiographs were retrospectively analyzed. 9162 radiographs were included in the study. If a coalition was found, affected bones, patient’s age and gender, clinical findings and concomitant hand abnormalities were recorded. Results: 29 CC cases, including 16 female (55.2%) and 13 male (44.8%) patients were found. The CC incidence was %0.3. Mean age was 34.6 (range between 13-80). There were 25 (86.3%) lunotriquetral coalitions (LTC), 2 capitate-trapezoid coalitions (CTC) (6.9%), 1 (3.4%) hamate-pisiform coalition (HPC), and 1 (3.4%) trapezium-trapezoid coalition (TTC) in the study population. There was non-traumatic wrist pain in 8 (27.5%) cases, and there was limited wrist motion in 1 (3.5%) case. 7 of 8 non-traumatic wrist pain cases had LTC, and 1 of 8 had HPC. LTC was found in the case with limited wrist motion. There was bilateral CC in one patient and concomitant oligodactyly in another one. Conclusion: CC is a rare and often asymptomatic developmental anomaly in our study which is performed with one of the most extensive series in the literature. LTC is the most frequent form. CC should be kept in mind in patients with wrist pain and limited wrist motion.

Lunotriquetral coalition and ulnar impaction syndrome: a pictorial essay.

Lunotriquetral coalition and ulnar impaction syndrome are among the spectrum of pathology encountered at the medial wrist. The co-existence of these entities in the same wrist is rare. The purpose of this pictorial essay is to present the etiology, clinical course, imaging findings, and treatment of lunotriquetral coalition and ulnar impaction syndrome, and co-existing disease.

Lunotriquetral coalition, a normal variant that may rarely cause ulnar sided wrist pain.

Lunotriquetral coalition (LTC), the most frequent and often bilateral type of carpal coalition, is in general considered as asymptomatic. In rare cases - however - fibrocartilaginous LTC may be an uncommon cause of ulnar sided pain in the wrist due to the pseudarthrosis or a post-traumatic disruption of LTC. Two rare cases of symptomatic LTC are presented and the role of MRI is emphasized. MRI shows the pseudarthrosis and may additionally show bone marrow edema and subcortical cysts. In symptomatic cases surgical lunotriquetral fusion may be considered as treatment option.

Pseudarthrosis after disruption of an incomplete luno-triquetral coalition: a case report.

Whilst bony luno-triquetral coalitions are known to be asymptomatic, fibro-cartilage unions can cause ulnar-sided wrist pain. The purpose is to present the rare case of painful pseudarthrosis after traumatic disruption of an incomplete luno-triquetral coalition. Recommendations for proper diagnosis and treatment options will be discussed. The case of a 35-year-old male patient is reported, where disruption of a fibro-cartilaginous luno-triquetral coalition resulted in a painful pseudarthrosis. Luno-triquetral fusion with a corticocancellous wedge from the iliac crest and a Herbert screw was undertaken. Using this method pain was relieved but resulted in minor loss of range of motion. We recommend luno-triquetral fusion in the rare case of fracture or pseudarthrosis of a luno-triquetral coalition. The use of a corticocancellous wedge should be considered depending on gap formation after resection of the pseudarthrosis.

Bildgebende Diagnostik der Lunatumnekrose

In recent years, our increased knowledge about the biomechanics of the wrist and reparative mechanisms in osteonecrotic bones has significantly influenced the imaging procedures in Kienböck's disease as well as its differential diagnosis. In addition to projection radiography, computed tomography (CT) is used for evaluating the osseous microstructure, and contrast-enhanced magnetic resonance imaging (MRI) for determining the viability of bone marrow. CT is essential in the morphological staging of Kienböck's disease due to its high sensitivity in detecting proximally located fractures (stage IIIa) and in visualising osteoarthritic lesions (stage IV). Bone marrow oedema of the lunate bone as well as the zonal layers including the proximal necrotic zone, the middle reparative zone, and the distal viability zone can be depicted only with the use of MRI. Furthermore, intravenous application of gadolinium is mandatory in MRI, because vascular differentiation of the osteonecrotic zone from the reparative zone is reliable only in MRI perfusion studies. By evaluating clinical, biomechanical and imaging findings synoptically, a differentiation of Kienböck's disease from ulnocarpal impaction syndromes, intraosseous ganglion cysts, the fibrocartilageous type of lunotriquetral coalition, and post-traumatic and inflammatory lesions is possible in over 80% of all cases.

Congenital lunotriquetral and capitotrapezoid coalitions

Congenital lunotriquetral and capitotrapezoid coalitions

Volar Intercalated Segmental Instability In Scaphoid Non-Union With Lunotriquetral Coalition: A Case Report

Scaphoid non-union is commonly encountered in clinical practice. Dorsal intercalated segmental instability is the most commonly seen carpal instability in scaphoid non-union. We present a case of ununited fracture scaphoid with lunotriquetral coalition which developed volar intercalated segmental instability due to altered biomechanics. Loss of radial support and increased mass on the ulnar aspect of the carpus resulted in the lunotriquetral mass going into abnormal flexion. We have attempted to explain the complex biomechanics leading to volar intercalated segmental instability in this case.

Chronic Wrist Pain - Rock Climbing

HISTROTY: 32yo female rock climber with a history of increasing left wrist pain. As a teen ager she had FOOSH injury to her right wrist while rock climbing and had xrays of both wrists demonstrating “bony abnormalities” needing a “cast.” Since, she has had pain while rock climbing. She never taped or braced. Currently, pain located dorsolateral/medial at the wrist and worse with hyperdorsiflexion such as pushing off and opening doors. No swelling or redness. No mechanical symptoms. No numbness or tingling. Elbow, shoulders and neck negative. Tried ibuprofen as needed but no physical therapy or bracing. History of patellar subluxation. PHYSICAL EXAMINATION: Inspection - no bony deformities, effusions or erythema. Symmetric active range of motion in all planes. Left wrist tender with terminal ulnar deviation. Palpation no nodules or masses but at the dorsal and volar ulnar aspects elicits some tenderness. Clicking at the ulnar aspect occurs with passive radial to ulnar deviation reported as uncomfortable. TFCC loading and table lift off test produces tenderness. Watson's scaphoid shift does not produce clicking or pain. Anatomic snuffbox palpation is negative. Tinel's is negative. Radial and ulnar pulses and sensation is intact and symmetric. Finger opposition strength is full. Hyper extension and abduction indicates laxity. DIFFERENTIAL DIAGNOSIS: TFCC tear. Carpal stress fracture. Scaphoid fracture non-union. Carpal instability. Distal radioulnar junction instability. TEST AND RESULTS: Plain film radiographs show lunotriquetral carpal coaltion. No scapholunate widening. MR Arthrography shows partial tears of ulnar attachment of TFCC without positive ulnar variance. Volar radioulnar ligament disruption with dorsal distal radioulnar joint subluxation. Lunotriquetral coalition, ulnar impaction. FINAL WORKING DIAGNOSIS: TFCC tear. DRUJ instability with dorsal subluxation. Lunotriquetral coalition. Ulnar impaction. Hyperlaxity. TREATMENT AND OUTCOMES: High dose NSAIDS and bracing. Cast immobilization deferred. Relative rest from rock climbing. At 4 months, intermittent pain with hyper dorsiflexion left greater than right. Refer to hand PT. At 6 months, improvement with relative rest but some symptoms with ADL's. Ortho Hand. Wrist taping for rock climbing.

Fracture through a congenital carpal coalition

Carpal coalition, sometimes referred to as carpal fusion, is a rare entity that occurs as an isolated defect or in conjunction with other congenital abnormalities. Multiple carpal coalitions and coalitions to the radius or ulna are rare without other anomalies. The most common coalition is the lunotriquetral, followed in incidence by capitohamate coalitions, with the others being much more uncommon. The incidence of the most common coalition is about 0.1% in white Americans, but is as high as 9.5% in Nigerian Hausa women.‘.’ Carpal coalitions are usually asymptomatic. There are no functional motion deficits with a coalition. Range of motion, as measured by Dean and Jones,3 showed an increase in radial deviation in children with carpal coalitions. Recently, there have been reports of symptomatic pisiform-hamate coalitions, as well as symptomatic, incomplete coalitions. Fractures of carpal coalitions are exceedingly rare, having only been reported in patients with lunotriquetral coalitions.2.4.5 Gross et a1.,6 in 1989, refuted the existence of fractures in Cockshott’s’ atraumatic patients in his 1963 study, suggesting that they were actually incomplete coalitions. There are no reports of fractures through other types of carpal coalitions. This study reports a case of a fracture through a trapezoid-capitate congenital coalition, and the successful treatment with a thumb spica cast.

Wide scapholunate joint space in lunotriquetral coalition: a normal variant?

The radiologic appearances of 70 lunotriquetral coalitions in 52 patients were evaluated to determine whether a wide scapholunate joint space in subjects with this congenital abnormality reflects a scapholunate ligament disruption or is a normal variant. When the middle of the scapholunate joint space was larger than the capitolunate or third carpometacarpal joint space widths, it was considered to be abnormally wide. In 32 of 70 wrists (46%), a wide scapholunate joint space was detected. Results of instability radiographic series (n = 28) and arthrography (n = 11) were normal with respect to the scapholunate ligament in all cases, but the scapholunate joint space was markedly widened in six cases (55%) in which arthrography was performed. Arthroscopy, performed in one case, showed an intact scapholunate ligament. Because of the high prevalence of a wide scapholunate joint space and because of negative arthrographic and arthroscopic examinations, the authors conclude that widening of the scapholunate joint space is a normal variant that is common in patients with lunotriquetral coalition.