Lunotriquetral coalition
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At the time the article was created Charlie Chia-Tsong Hsu had no recorded disclosures.
View Charlie Chia-Tsong Hsu's current disclosuresAt the time the article was last revised Henry Knipe had the following disclosures:
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View Henry Knipe's current disclosures- Lunate-triquetral coalition
- Lunato-triquetral coalition
- Triquetral-lunate coalition
- Luno-triquetral coalition
- Luno-triquetral fusion
- Luno-triquetral synostosis
- Luno-triquetral coalitions
- Luno-triquetral synostoses
- Lunotriquetral synostoses
- Lunotriquetral coalitions
A lunotriquetral coalition, also known as lunotriquetral fusion or synostosis, is a type of carpal coalition representing a congenital lack of separation of the lunate and triquetral bones of the carpus.
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Terminology
The term coalition is preferred over fusion for congenital coalitions, as during development, the discrete carpal bones form by a process of separation. The lunate and triquetral do not form and then later fuse; they just never separate or only do so partially (hence incomplete coalitions) 9.
Epidemiology
Lunotriquetral coalition has a prevalence of ~0.1% (range 0.08-0.13%) 11. It is more common in females (F:M = 2:1) and African Americans.
Diagnosis
Typical imaging findings can establish the diagnosis.
Clinical presentation
Whilst osseous coalitions of the lunate and the triquetrum are known to be asymptomatic, fibrocartilaginous lunotriquetral coalitions can present as an uncommon cause of ulnar-sided wrist pain often due to pseudarthrosis or a post-traumatic disruption 3,8.
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Pathology
Congenital lunotriquetral coalition occurs with failure of segmentation of the carpal bones 1. The coalition may be fibrous, cartilaginous or osseous 5, and is commonly bilateral 4.
Classification
deVilliers Minnaar classified lunotriquetral coalition into four types 10:
type 1: incomplete fibrocartilaginous fusion resembling a pseudoarthrosis
type 2: incomplete osseous fusion
type 3: complete osseous fusion
type 4: complete osseous fusion with other carpal abnormalities
Type 1 are the most symptomatic (secondary to degenerative change) but is also least common type of lunotriquetral coalition. Types 2-4 are usually asymptomatic 11.
Radiographic features
Plain radiograph
partial or complete fusion of the lunate and triquetrum
a distal notch at the site of incomplete separation may be seen in incomplete coalition 1
~45% have a widened scapholunate interval 1,4
Treatment and prognosis
A lunotriquetral coalition is usually an incidental finding which does not require treatment if asymptomatic 11. It might occasionally be the cause of chronic wrist pain (especially in types 1 6,11). Fracture through a lunotriquetral coalition can also occur ref.
References
- 1. 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
- 2. Marburger R & Burgess R. Symptomatic Lunate-Triquetral Coalition. J South Orthop Assoc. 1995;4(4):307-10. - Pubmed
- 3 .van Schoonhoven J, Prommersberger K, Schmitt R. Traumatic Disruption of a Fibrocartilage Lunate-Triquetral Coalition — a Case Report and Review of the Literature. Hand Surg. 2001;06(01):103-8. doi:10.1142/s0218810401000497
- 4. D. Lee Bennett, Georges Y. El-Khoury. Pearls and Pitfalls in Musculoskeletal Imaging. (2013) ISBN: 9780521196321 - Google Books
- 5. Jacob Mandell. Core Radiology. (2013) ISBN: 9781107679689 - Google Books
- 6. 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
- 7. Davis D. Lunotriquetral Coalition and Ulnar Impaction Syndrome: A Pictorial Essay. Radiol Bras. 2019;52(2):112-6. doi:10.1590/0100-3984.2017.0085 - Pubmed
- 8. Mespreuve M, Vanhoenacker F, Verstraete K. Lunotriquetral Coalition, a Normal Variant That May Rarely Cause Ulnar Sided Wrist Pain. JBR-BTR. 2015;98(2):72-8. doi:10.5334/jbr-btr.769 - Pubmed
- 9. 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
- 10. Minnaar A. Congenital Fusion of the Lunate and Triquetral Bones in the South African Bantu. The Journal of Bone and Joint Surgery British Volume. 1952;34-B(1):45-8. doi:10.1302/0301-620x.34b1.45 - Pubmed
- 11. Chiri W & Bain G. Arthroscopic Resection of Lunotriquetral Coalition. Arthroscopy Techniques. 2022;11(4):e491-5. doi:10.1016/j.eats.2021.11.022 - Pubmed
Incoming Links
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