Page 21 - Delaware Medical Journal - March/April 2019
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CASE REPORT
FIGURE 5
ABC
FIGURE 6
A. Left LT coalition, girl, age 13y9m old with fusion between the lunate and triquetrum involving the proximal half with an unfused cleft at the distal half
B. Left LT fusion, girl age 16y, compared with 5A (2 years before) shows that the fusion line has advanced; the distal cleft has decreased to less than 40% of the proximal-distal width of the two bones
C. Right LT fusion, girl, age 16y. A contralateral radiograph (to 5A and 5B) showed a similar fusion between the lunate and triquetrum with a very small distal cleft. LT, luno-triquetral
ABCD
A. Left CH coalition, girl with Leri-Weill dyschondrosteosis syndrome, age 1y6m B. Left CH coalition, girl with Leri- Weill dyschondrosteosis syndrome, age 4y9m C. Left CH coalition, girl with Leri-Weil dyschondrosteosis syndrome, age 5y3m D. Left CH coalition, girl with Leri-Weill dyschondrosteosis syndrome, age 7y4m. CH, capito-hamate
notch similar in appearance to the distal notch seen in case 3 (Figs. 4A-B).
Case 5 shows a left wrist radiograph of a 13-year-9-month-old female with fusion between the lunate and triquetrum involving the proximal half with an unfused cleft at the distal half. A radiograph two years later (age 16 years) shows that the sclerotic fusion line has advanced; the distal cleft has decreased to less than 40% of the proximal-distal width of the two bones (Figs. 5A-B). A contralateral radiograph was also taken at age 16, which showed a similar fusion between the lunate and triquetrum with a very small distal cleft and lack of sclerotic line (Fig. 5C).
Cases 6 through 8 presented very similar patterns of evolution as cases 1 and 3.
Capito-hamate coalition
The capitate ossicle is larger than the hamate, which differs from the Greulich and Pyle study.25 Case 9, a female with Leri-Weill dyschondrosteosis syndrome, is an index case for CH coalition. The
hamate ossicle than what is seen in the Greulich and Pyle atlas for the same skeletal age. The next radiographs — at 4 years 9 months, 5 years 3 months, and 7 years 4 months — show a well-developed CH coalition (Figs. 6A-D).
Case 10 also involves initial bilateral radiographs at 2 years 7 months that show bilaterally enlarged hamate ossicles relative to the 2-years 6-months Greulich and Pyle reference (Figs. 7A-B).
1 year 0 months shows bilaterally the ossicles of hamate are larger than the capitate ossicles. The next radiographs show the joint space between the capitate and hamate has decreased and fused (4 years 9 months and 5 years 3 months). A CH coalition in the left wrist is clearly visible. The right wrist shows a very narrow joint space between the capitate and hamate, suggesting a developing contralateral CH coalition as well (Figs. 8A-C). In case 12, the evolution of coalition followed the pattern of case 11.
Del Med J | March/April 2019 | Vol. 91 | No. 2
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