Carpal Coalition

Abstract

Background Carpal coalition is a relatively common, yet poorly recognized, anomaly that may present independently or in association with syndromic or metabolic disorders. While largely asymptomatic, symptoms may manifest secondary to biomechanical stress at the site of fusion. The purpose of this report is to describe 103 cases of carpal synostosis and provide a review of the etiology, classification, and clinical significance of intercarpal fusion. Methods Retrospective review of medical and radiographic records was conducted on all patients with identified carpal coalitions, between 2008 and 2012, at our institution. Demographic and historical data regarding trauma, infection, documented joint disease, and prior wrist symptomatology were analyzed for each case, and radiographic evaluation of carpal alignment was performed. Results A total of 103 cases of carpal coalition, among 85 individuals, were reviewed. All cases presented asymptomatically with the highest proportion noted among individuals of African-Caribbean descent. The most frequent variant in our study population was lunate-triquetral coalition, which was present in 92 of the 103 identified cases. None of the cases evaluated in this study demonstrated clinical or radiographic evidence of carpal mal-alignment or instability. Conclusion The results of our investigation demonstrate that carpal coalition presented most frequently among individuals of African-Caribbean descent. While the prevalence of this condition has yet to be studied specifically in Hispanic and African-Caribbean populations, our findings may reflect the genetic linkage between these and certain West African populations. To our knowledge, this represents the largest clinical series of carpal coalition in the English literature.

Capitate-trapezoid synostosis: analysis of an Early Bronze Age case and review of the literature

“…The most frequent pattern recorded in the literature is the lunate-triquetral synostosis [14,39,42]. From a paleopathological perspective, the most ancient case of synostosis of carpal bones, namely a lunate-triquetral coalition, was found in a Neanderthal individual dated at 74.000 to 68.000 years BP [32].…”

“…From a paleopathological perspective, the most ancient case of synostosis of carpal bones, namely a lunate-triquetral coalition, was found in a Neanderthal individual dated at 74.000 to 68.000 years BP [32]. In contrast, CTS has a very uncommon occurrence [14,39,42], with only sparse data available in the literature. Of note, a systematic review of the existing literature on CTS is currently lacking.…”

“…Although in the Caucasian population the reported prevalence of 0.1% is routinely accepted as the best approximation [7,12,14], the true frequency of CC in the general population is largely unknown as many cases are asymptomatic and often remain undiagnosed. The most common type is lunate-triquetral synostosis, which accounts for around 90% of all cases in adults [14] and 69.2% of all cases in the paediatric population [39].…”

“…Here, a developmental failure occurs between the 4 th to 8 th week of embryonic life at the site of the future joint space, followed by chondrification of the articular interzone that causes lack of separation of two or more carpal bones [12,19]. The true preva-lence of CC in the general population is not well defined and estimates vary considerably across different ethnic groups [7,14,39,42]. In the vast majority of cases, CC represents an isolated, often asymptomatic, defect involving two adjacent bone elements of the same carpal row.…”

“…The most common situation implicates lunate and triquetral coalition, followed by the joining of capitate and hamate bones [14,39,42]. In contrast, capitate-trapezoid synostosis (CTS) is assumed to be quite rare [14,39,42], only a few cases having been reported in the literature. Notably, a complete overview of such sparse data is missing.…”