Trans-scaphoid Trans-lunotriquetral Perilunate Dislocation in a Patient with a Carpal Coalition

Abstract

Summary:Congenital carpal coalitions are rare conditions that arise from a failure or an incomplete cavitation of a common cartilaginous precursor of the carpal bones between the fourth and eighth week of intrauterine life. The incidence of coalitions has been estimated to occur in about 0.1% of the population and up to 1.6% in people of African descent. This study reports a case of trans-scaphoid trans-lunotriquetral perilunate dislocation with a lunotriquetral coalition and successful management with closed reduction, percutaneous fixation, and a thumb spica cast.

Lunotriquetral coalition and ulnar impaction syndrome: a pictorial essay

“…The carpus of the wrist arises from undifferentiated mesenchyme between the fourth and eighth weeks of fetal life ( 1 ) . All carpal bones originate normally from a single cartilaginous anlage.…”

“…Carpal coalition is a rare developmental anomaly, and the incidence is 0.1% and 1.6% in white and black populations, respectively ( 1 ) . Lunotriquetral coalition is by far the most common form of carpal coalition, representing nearly 90% of all cases ( 1 , 4 ) . Lunotriquetral coalition is classified by the degree of bony synostosis between the lunate and triquetrum (Figures 1 and 2).…”

“…The presence of lunotriquetral coalition and ulnar impaction syndrome in the same wrist is rare. The rarity of this combination stems from the fact that lunotriquetral coalition is only present in less than 2% of the population ( 1 ) , although the true incidence of co-existent disease with ulnar impaction syndrome is unknown. To the author's knowledge, no prior case of congenital lunotriquetral coalition has been reported in combination with ulnar impaction syndrome in the literature.…”

Abnormal type III fusion between lunate and triquetrum: A case report

“…The fibrocartilaginous lunotriquetral coalitions might lead to ulnar-sided wrist pain, ulnar nerve paresthesia, and an enhanced risk of the degenerative complications due to the pseudarthrosis or a post-traumatic disturbance [ 1 ]. Embryological carpal fusion or congenital carpal synchondrosis occurs due to insufficient segmentation of the carpal cartilage, failure of cavitation of the cartilaginous hand bud precursor, or undifferentiated mesenchyme during the fourth to eighth week of gestation, which later develops to a complete or incomplete fusion [ 5 ]. Usually, apoptotic cell death results in cleft before the 10th intrauterine week, and the degree of this apoptosis defines the degree of complete or incomplete fusion.…”

Lunotriquetral Coalition: An Unusual Cause of Wrist Pain

“…De Villiers Minnaar developed a classification scheme for lunotriquetral coalition based on radiographic assessment, which is composed of four types. Minnaar’s classification focuses more on the osseous (types two and three) types of fusions, compiling all the non-osseous (type one) types into one category [5]. In this article, our aim is to present the case of a patient with the above condition, which, while not novel, warrants discussion due to its rarity in Pakistan.…”