Carpal coalition
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View Yuranga Weerakkody's current disclosuresAt the time the article was last revised Matt Skalski had no financial relationships to ineligible companies to disclose.
View Matt Skalski's current disclosures- Coalition of carpal bones
Carpal coalition refers to the abnormal union of two or more carpal bones, and is usually congenital, due to failure of separation of 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 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), cartilaginous (synchondrosis), or fibrous (syndesmosis).
Etiology
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 of congenital carpal coalition are:
- lunotriquetral coalition: much more common than all other types combined
- capitohamate coalition
Less common
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
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