Carpal coalition

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Carpal coalition refers to failure of separation of two or more carpal bones, and although the most commonly involved bones are the lunate and triquetrum, most combinations of adjacent bones can be found to be coalesced.

Terminology

Carpal fusion is a misnomer, as it is the failure of normal segmentation of carpal mesenchyme that results in the anomaly ⁸. Carpal coalition is less contentious as its definition means a connection between two bones, it says nothing about how they came to be connected ⁹.

Epidemiology

The estimated prevalence is ~0.1% in Caucasian Americans and ~1.5% in African Americans, and it tends to affect women more commonly ^1,2.

Associations

There are several associated conditions, especially with multiple coalitions:

Pathology

As with tarsal coalition, congenital carpal coalition can either be osseous ~~(synostosis~~(synostosis), cartilaginous (synchondrosis), or fibrous (syndesmosis).

Aetiology

Non-syndromic congenital carpal coalition is transmitted via a Mendelian inheritance pattern. Acquired intercarpal fusion can either be a consequence of an inflammatory arthropathy (e.g.rheumatoid arthritis, psoriatic arthritis, reactive arthritis) or injury, or due to intentional surgical arthrodesis.

Types

The two most common types are:

lunotriquetral coalition: much more common than all other types combined
capitohamate coalition

References changed:

1. Timins M. Osseous Anatomic Variants of the Wrist: Findings on MR Imaging. AJR Am J Roentgenol. 1999;173(2):339-44. <a href="https://doi.org/10.2214/ajr.173.2.10430131">doi:10.2214/ajr.173.2.10430131</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/10430131">Pubmed</a>
2. Resnik C, Grizzard J, Simmons B, Yaghmai I. Incomplete Carpal Coalition. AJR Am J Roentgenol. 1986;147(2):301-4. <a href="https://doi.org/10.2214/ajr.147.2.301">doi:10.2214/ajr.147.2.301</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/3487948">Pubmed</a>
3. Metz V, Schimmerl S, Gilula L, Viegas S, Saffar P. Wide Scapholunate Joint Space in Lunotriquetral Coalition: A Normal Variant? Radiology. 1993;188(2):557-9. <a href="https://doi.org/10.1148/radiology.188.2.8327715">doi:10.1148/radiology.188.2.8327715</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/8327715">Pubmed</a>
4. Sferopoulos N & Tsitouridis I. Carpal Coalition: A Rare Coincidence with Hand Deficiencies. Acta Orthop Belg. 2003;69(4):317-20. - <a href="https://www.ncbi.nlm.nih.gov/pubmed/14526635">Pubmed</a>
5. Tada K, Egawa T, Ono K. The Carpus in Congenital Anomalies of the Hand. Acta Orthop Scand. 1977;48(6):592-9. <a href="https://doi.org/10.3109/17453677708994803">doi:10.3109/17453677708994803</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/564593">Pubmed</a>
6. Imamura T & Miura T. The Carpal Bones in Congenital Hand Anomalies: A Radiographic Study in Patients Older Than Ten Years. J Hand Surg Am. 1988;13(5):650-6. <a href="https://doi.org/10.1016/s0363-5023(88)80117-5">doi:10.1016/s0363-5023(88)80117-5</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/3241032">Pubmed</a>
7. Defazio M, Cousins B, Miversuski R, Cardoso R. Carpal Coalition: A Review of Current Knowledge and Report of a Single Institution's Experience with Asymptomatic Intercarpal Fusion. Hand (N Y). 2013;8(2):157-63. <a href="https://doi.org/10.1007/s11552-013-9498-5">doi:10.1007/s11552-013-9498-5</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/24426912">Pubmed</a>
8. Aucourt J, Budzik J, Manouvrier-Hanu S, Mézel A, Cotten A, Boutry N. Congenital Malformations of the Hand and Forearm in Children: What Radiologists Should Know. Semin Musculoskelet Radiol. 2012;16(2):146-58. <a href="https://doi.org/10.1055/s-0032-1311766">doi:10.1055/s-0032-1311766</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/22648430">Pubmed</a>
9. Dorland W. Dorland's Illustrated Medical Dictionary. (2007) ISBN: 9781416023647 - <a href="http://books.google.com/books?vid=ISBN9781416023647">Google Books</a>
1. Timins ME. Osseous anatomic variants of the wrist: findings on MR imaging. AJR Am J Roentgenol. 1999;173 (2): 339-44. <a href="http://www.ajronline.org/cgi/content/citation/173/2/339">AJR Am J Roentgenol (citation)</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/10430131">Pubmed citation</a><div class="ref_v2"></div>
2. Resnik CS, Grizzard JD, Simmons BP et-al. Incomplete carpal coalition. AJR Am J Roentgenol. 1986;147 (2): 301-4. <a href="http://www.ajronline.org/cgi/content/abstract/147/2/301">AJR Am J Roentgenol (abstract)</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/3487948">Pubmed citation</a><div class="ref_v2"></div>
3. Metz VM, Schimmerl SM, Gilula LA et-al. Wide scapholunate joint space in lunotriquetral coalition: a normal variant? Radiology. 1993;188 (2): 557-9. <a href="http://radiology.rsna.org/content/188/2/557.abstract">Radiology (abstract)</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/8327715">Pubmed citation</a><div class="ref_v2"></div>
4. Sferopoulos NK, Tsitouridis I. Carpal coalition: a rare coincidence with hand deficiencies. Acta Orthop Belg. 2003;69 (4): 317-20. <a href="http://www.ncbi.nlm.nih.gov/pubmed/14526635">Pubmed citation</a><span class="ref_v3"></span>
5. Tada K, Egawa T, Ono K. The carpus in congenital anomalies of the hand. Acta Orthop Scand. 1978;48 (6): 592-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/564593">Pubmed citation</a><span class="ref_v3"></span>
6. Imamura T, Miura T. The carpal bones in congenital hand anomalies: a radiographic study in patients older than ten years. J Hand Surg Am. 1989;13 (5): 650-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/3241032">Pubmed citation</a><span class="ref_v3"></span>
7. Defazio MV, Cousins BJ, Miversuski RA, Cardoso R. Carpal coalition: A review of current knowledge and report of a single institution's experience with asymptomatic intercarpal fusion. Hand (New York, N.Y.). 8 (2): 157-63. <a href="https://doi.org/10.1007/s11552-013-9498-5">doi:10.1007/s11552-013-9498-5</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/24426912">Pubmed</a> <span class="ref_v4"></span>
8. Julie Aucourt, Jean-François Budzik, Sylvie Manouvrier-Hanu, Aurélie Mézel, Anne Cotten, Nathalie Boutry. Congenital Malformations of the Hand and Forearm in Children: What Radiologists Should Know. (2012) Seminars in Musculoskeletal Radiology. 16 (02): 146. <a href="https://doi.org/10.1055/s-0032-1311766">doi:10.1055/s-0032-1311766</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/22648430">Pubmed</a> <span class="ref_v4"></span>
9. William Alexander Newman Dorland. Dorland's Illustrated Medical Dictionary. (2018) <a href="https://books.google.co.uk/books?vid=ISBN9781416023647">ISBN: 9781416023647</a><span class="ref_v4"></span>