Carpal coalition
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View Yuranga Weerakkody's current disclosuresAt the time the article was last revised Magdi Mahsoub had no financial relationships to ineligible companies to disclose.
View Magdi Mahsoub's current disclosures- 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.
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Terminology
Carpal fusion is a misnomer, as the failure of normal segmentation of carpal mesenchyme results in this anomaly 7,8. Carpal coalition is a less contentious term 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 probably <1%, although it has been reported to be as high as ~9.5% 1,2,7,11,14,15. There may be a high prevalence in African Americans or West Africans 1,2,7,11,15.
Clinical presentation
Carpal coalitions are usually asymptomatic and discovered incidentally 11,12.
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Pathology
As with tarsal coalition, congenital carpal coalition can either be osseous (synostosis), cartilaginous (synchondrosis), or fibrous (syndesmosis) or mixture of types 16. They can often be bilateral 16.
Etiology
Carpal coalitions can be 11
-
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
Incoming Links
- Lunotriquetral coalition
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- Lunotriquetral coalition
- Capitotrapezoid coalition
- TFCC tear and lunotriquetral coalition
- Bilateral lunotriquetral coalition
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