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Carpal Coalition: Is It Really Rare and Incidental Finding?

Orhan Oyar,Atilla Hikmet Cilengir,Yusuf Kenan Cetinoglu,Muhsin Engin Uluc.

Abstract
Objectives: Carpal coalition (CC) defines the combined development of two or more carpal bones. The diagnosis is often made incidentally by the radiographs. Incidence of CC changes with ethnicity. CC may cause various symptoms because of the coalition type and the affected bones. We aim to analyze the incidence of CC, affected bones, define the symptoms and find out the correlation between CC, demographic factors and associated hand anomalies.
Methods: A total of 9457 hand and wrist AP radiographs were retrospectively analyzed. 9162 radiographs were included in the study. If a coalition was found, affected bones, patientís age and gender, clinical findings and concomitant hand abnormalities were recorded.
Results: 29 CC cases, including 16 female (55.2%) and 13 male (44.8%) patients were found. The CC incidence was %0.3. Mean age was 34.6 (range between 13-80). There were 25 (86.3%) lunotriquetral coalitions (LTC), 2 capitate-trapezoid coalitions (CTC) (6.9%), 1 (3.4%) hamate-pisiform coalition (HPC), and 1 (3.4%) trapezium-trapezoid coalition (TTC) in the study population. There was non-traumatic wrist pain in 8 (27.5%) cases, and there was limited wrist motion in 1 (3.5%) case. 7 of 8 non-traumatic wrist pain cases had LTC, and 1 of 8 had HPC. LTC was found in the case with limited wrist motion. There was bilateral CC in one patient and concomitant oligodactyly in another one.
Conclusion: CC is a rare and often asymptomatic developmental anomaly in our study which is performed with one of the most extensive series in the literature. LTC is the most frequent form. CC should be kept in mind in patients with wrist pain and limited wrist motion.

Key words: Carpal bones, Coalition, Radiography, Wrist joint


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