Presentation
Right anatomical snuff box tenderness after falling down. Slight pain on ulnar deviation.
Patient Data
Case Discussion
Often, when patients present with anatomical snuffbox tenderness, the scaphoid is the usual carpal bone suspected of pathology. However, in this unique case, the patient had an incidental finding of carpal coalition with no lucent lines to demonstrate a fracture through any particular carpal bone.
Carpal coalition is an anatomical variant that may present 1:
independently
in association with syndromic or metabolic disorders
The literature recounts that independent fusions often only involve two bones in the same row, while syndromic-associated fusions involve multiple. Furthermore, the most frequently involved carpal bones tend to occupy the same row and are located in the ulnar region.
When coalition cases are asymptomatic or mildly symptomatic, conservative management is sufficient. However, in instances where the severity and duration of pain justifies surgical intervention, compression of the involved bones (i.e. wrist arthrodesis) "has demonstrated good reliability with acceptable effects on postoperative wrist motion" 1.
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