Page 18 - Delaware Medical Journal - March/April 2019
P. 18
Evolution of Carpal Coalition Based on Series Radiographs
Blazej Pruszczynski, MD; Lauren W. Averill, MD; Kenneth J. Rogers, PhD, ATC; Jeremy M. Saller, MD; Jennifer Ty, MD
Carpal coalition is a relatively uncommon radiological finding, estimated at 7:10,000 to 7:1,000 in Caucasian adults. We aim to demonstrate the sequence of developing wrist carpal coalition, highlighting the time course and expected radiographic findings before bony fusion is complete. We identified 104 cases of carpal coalition. Twelve patients (18 wrists) had sequential radiography demonstrating development of carpal coalition. Luno-triquetral coalitions progress radiographically in a typical sequence and can be observed in children at approximately 7 to 13 years of age. Capito- hamate coalitions occur earlier in childhood, with bony fusion present by age 6 years.
KEY WORDS: bone fusion, carpal coalition, evolution, radiology
INTRODUCTION
1-4 in Caucasian adults and up to 9.5:100 in African and African American populations.1, 5-14 It is usually asymptomatic and found incidentally on radiographs taken for another reason. The two most frequent CCs are luno-triquetral 6, 7, 11, 14-22 and capito-hamate (CH).4,11 Carpal coalition occurs due to the failure of cavitation of the cartilaginous precursor during the fourth to eighth weeks of intrauterine development.23
it begins with the capitate and ends with the pisiform. At birth,
age; hamate, 2 to 4 months of age; triquetral, 2 to 3 years of
age; lunate, 2 to 4 years of age; scaphoid, 4 to 6 years of age; trapezium, 4 to 6 years of age; trapezoid, 4 to 6 years of age; and pisiform, 8 to 12 years of age.24
An article on the development of carpal bone fusion seen in serial 14 Hughes and Tanner described CC development based on seven cases found after
Table 1. List of cases
Case
Sex
Type
Site
Age at first radiograph
Age at last radiograph
No. of radiographs
Reason for radiograph
1
M
LT
B
4y6m
9y6m
6
Clinodactyly of small fingers
2
F
LT
L
7y11m
12y0m
2
Wrist injury – no obvious fracture
3
F
LT
R
8y8m
12y5m
2
Thumb injury
4
M
LT
L
13y5m
13y9m
2
Wrist injury – SH II fracture of distal radius and ulna
5
F
LT
B
13y9m
16y3m
2
Wrist injury – no obvious fractures
6
F
LT
B
4y0m
12y4m
2
Bone age – primordial dwarfism
7
M
LT
R
8y7m
12y4m
3
Wrist injury – no obvious fracture
8
F
LT
B
7y4m
11y6m
4
Bone age – syndromic scoliosis
9
F
CH
L
4y2m
7y4m
4
Leri-Weil dyschondrosteosis syndrome
10
M
CH
L
2y7m
6y0m
2
Bone age – short stature
11
M
CH
B
1y0m
5y3m
4
Apert syndrome
12
M
CH
B
1 week
2y3m
2
Ellis-van Creveld syndrome
B, bilateral; L, left; R, right; M, male; F, female; LT, luno-triquetral; SH II, Salter-Harris type II; CH, capito-hamate
66 Del Med J | March/April 2019 | Vol. 91 | No. 2
Abstract
