Carpal coalition

Last revised by Magdi Mahsoub on 3 Mar 2025

Citation, DOI, disclosures and article data

Citation:

Weerakkody Y, Mahsoub M, Sharma R, et al. Carpal coalition. Reference article, Radiopaedia.org (Accessed on 15 Mar 2025) https://doi.org/10.53347/rID-10789

DOI:

https://doi.org/10.53347/rID-10789

Permalink:

https://radiopaedia.org/articles/10789?embed_domain=hackmd.io%252F%2540yipuafecsl2jsu8smr5njq%252Fbnjhjgjghjghjghfavicon.ico

rID:

10789

Article created:

21 Sep 2010, Yuranga Weerakkody ◉

Disclosures:

At the time the article was created Yuranga Weerakkody had no recorded disclosures.

View Yuranga Weerakkody's current disclosures

Last revised:

3 Mar 2025, Magdi Mahsoub

Disclosures:

At the time the article was last revised Magdi Mahsoub had no financial relationships to ineligible companies to disclose.

View Magdi Mahsoub's current disclosures

Revisions:

30 times, by 21 contributors - see full revision history and disclosures

Systems:

Musculoskeletal

Sections:

Anatomy

Tags:

carpus

Synonyms:

Coalition of carpal bones
Congenital carpal synostosis
Carpal synostosis
Congenital carpal coalition

Carpal coalition refers to the abnormal union of two or more carpal bones. It is usually congenital and results from the failure to separate the involved bones during development. The most commonly involved bones are the lunate and triquetrum, although many combinations of united bones have been reported.

syndromic
- more likely to involve >2 carpal bones and cross carpal rows ^11,12
- there are several associated syndromes including Ellis-van Creveld syndrome, fetal alcohol syndrome, Holt-Oram syndrome, otopalatodigital spectrum disorders, arthrogryposis, Turner syndrome, symphalangism, Nievergelt syndrome ^7,11,12
isolated
- more likely to involve 2 carpal bones and a single carpal row ¹¹
- transmitted via a Mendelian inheritance pattern ^11,13
acquired
- post inflammatory arthropathy, e.g. rheumatoid arthritis, psoriatic arthritis, juvenile idiopathic arthritis, reactive arthritis ⁷
- post-traumatic ⁷
- iatrogenic, i.e. intentional surgical arthrodesis ⁷

Types

Almost every combination of carpal coalition have been recorded

lunotriquetral coalition: most common ^7,11,15
capitohamate coalition: second most common ^7,11,15

Other much less common types include:

pisiform-hamate coalition ¹⁰
capitate-trapezoid coalition ¹³

References

1. Timins M. Osseous Anatomic Variants of the Wrist: Findings on MR Imaging. AJR Am J Roentgenol. 1999;173(2):339-44. doi:10.2214/ajr.173.2.10430131 - Pubmed
2. Resnik C, Grizzard J, Simmons B, Yaghmai I. Incomplete Carpal Coalition. AJR Am J Roentgenol. 1986;147(2):301-4. doi:10.2214/ajr.147.2.301 - Pubmed
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. doi:10.1148/radiology.188.2.8327715 - Pubmed
4. Sferopoulos N & Tsitouridis I. Carpal Coalition: A Rare Coincidence with Hand Deficiencies. Acta Orthop Belg. 2003;69(4):317-20. - Pubmed
5. Tada K, Egawa T, Ono K. The Carpus in Congenital Anomalies of the Hand. Acta Orthop Scand. 1977;48(6):592-9. doi:10.3109/17453677708994803 - Pubmed
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. doi:10.1016/s0363-5023(88)80117-5 - Pubmed
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. doi:10.1007/s11552-013-9498-5 - Pubmed
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. doi:10.1055/s-0032-1311766 - Pubmed
9. Dorland W. Dorland's Illustrated Medical Dictionary. (2007) ISBN: 9781416023647 - Google Books
10. Burnett S. Hamate-Pisiform Coalition: Morphology, Clinical Significance, and a Simplified Classification Scheme for Carpal Coalition. Clin Anat. 2011;24(2):188-96. doi:10.1002/ca.21086 - Pubmed
11. Spaans A & Beumer A. Carpal Coalitions; Failures of Differentiation of the Carpus: A Description of Cases. OJRad. 2013;03(01):1-6. doi:10.4236/ojrad.2013.31001
12. Gottschalk M, Danilevich M, Gottschalk H. Carpal Coalitions and Metacarpal Synostoses: A Review. Hand (N Y). 2016;11(3):271-7. doi:10.1177/1558944715614860 - Pubmed
13. Christ A, Maertens A, Weiland A. Bilateral Complete Osseous Coalition of the Capitate and Trapezoid. J Wrist Surg. 2016;5(3):233-5. doi:10.1055/s-0036-1579548 - Pubmed
14. van Hoorn B, Pong T, van Leeuwen W, Ring D. Carpal Coalitions on Radiographs: Prevalence and Association With Ordering Indication. J Hand Surg Am. 2017;42(5):329-34. doi:10.1016/j.jhsa.2017.02.002 - Pubmed
15. Pruszczynski B, Saller J, Rogers K, Holmes L, Ty J. Incidence of Carpal Coalition in the Pediatric Population. Journal of Pediatric Orthopaedics. 2016;36(8):e106-10. doi:10.1097/bpo.0000000000000639 - Pubmed
16. Mespreuve M, Bosmans F, Waked K, Vanhoenacker F. Hand and Wrist: A Kaleidoscopic View of Accessory Ossicles, Variants, Coalitions, and Others. Semin Musculoskelet Radiol. 2019;23(05):511-22. doi:10.1055/s-0039-1693974