Imaging Findings

The patient is a 58-year-old male who complains of wrist pain after a fall. X-ray findings:

• A fusion shadow is visible between some carpal bones, suggesting carpal coalition (possibly involving the lunate and triquetrum or the capitate and hamate).
• The bony contour at the fusion site appears relatively smooth, yet partial or incomplete fusion is noted, which may indicate a pseudoarthrosis or incomplete fusion.
• In the area near the fusion (or in adjacent carpal bones), interrupted trabecular pattern and localized density abnormalities suggest a fracture line.
• No obvious signs of soft tissue swelling, and no significant bone displacement or large fracture fragments are identified, indicating a mild or incomplete fracture.

Potential Diagnosis

Based on the imaging findings and the patient’s history of wrist pain after a fall, the following diagnoses are considered:

1. Carpal Coalition with Associated Carpal Fracture:
   The site of fusion is often observed between the lunate and triquetrum or the capitate and hamate. Incomplete fusion may form a pseudoarthrosis. Trauma from a fall can result in fracture or joint surface injury, causing pain.
2. Other Traumatic Carpal Fractures (such as scaphoid or nearby carpal bones):
   Although coalition is clearly visible, common carpal fractures must be excluded, as they can present similarly after trauma.
3. Degenerative Changes or Osteoarthritis:
   An incomplete fusion might exhibit degenerative changes, joint wear, or pseudoarthrosis-related pain. However, acute pain is more commonly associated with fracture or acute soft tissue injury.

Final Diagnosis

Combining the patient’s age, history of falling injury, and X-ray findings, the most likely diagnosis is:

“Congenital Carpal Coalition (Carpal Coalition) with Carpal Fracture.”

To further clarify the extent of the fracture line and any articular surface damage, MRI or CT may be used to guide a more precise treatment plan.

Treatment Plan and Rehabilitation Strategy

Based on this diagnosis, the following treatment and rehabilitation suggestions are recommended:

1. Treatment Strategy

• Conservative Treatment: For mild fractures without significant displacement, a cast or brace can be used to reduce wrist joint movement and promote bone healing. Pain and fracture healing should be monitored throughout immobilization.
• Medication: Pain management typically involves NSAIDs. Anti-inflammatory medication or topical remedies may also be used to alleviate local discomfort.
• Surgical Intervention: If fracture alignment is poor, the pseudoarthrosis is pronounced, or there is severe articular damage, surgical fixation or reconstructive surgery may be required. In certain cases, fusion surgery may be performed to stabilize the wrist.

2. Rehabilitation / Exercise Prescription Recommendations (FITT-VP Principle)

During the wrist healing phase, rehabilitation should gradually restore range of motion and strength:

• Phase 1 (Acute Protective Phase, approx. 0–2 weeks):
  • Immobilize or use a brace to protect the wrist joint and limit unnecessary movement.
  • Perform active movements of the shoulder, elbow, and other joints to avoid stiffness caused by prolonged immobilization.
  • Frequency: 2–3 times per day, light intensity.
• Phase 2 (Initial Functional Recovery, approx. 2–6 weeks):
  • After removal or reduction of immobilization, begin gentle active wrist movements, such as making a fist, wrist extension, and wrist flexion.
  • Consider using light resistance bands, taking care to avoid excessive load.
  • Frequency: 3–4 times per week for about 10–15 minutes each session, at low to moderate intensity.
• Phase 3 (Muscle Strength and Stability Training, approx. 6 weeks and beyond):
  • With confirmed fracture healing and stable coalition, progressively increase resistance exercises for the wrist, such as using a hand gripper, light dumbbells, or resistance training equipment.
  • Monitor wrist pain or discomfort, adjusting training volume as needed.
  • Frequency: 3–5 times per week, 15–20 minutes each session, moderate intensity, gradually increasing.

Throughout the rehabilitation process, closely monitor changes in pain, swelling, and range of motion. If severe pain or a decline in range of motion occurs, prompt medical re-evaluation is advised.

Special Considerations: When osteoporosis, advanced age, or other comorbidities (e.g., compromised cardiopulmonary function) are present, treatment intensity and frequency should be personalized. If needed, undergo rehabilitation under the guidance of a professional rehabilitation therapist.

Disclaimer: This report is based on available information and is intended for reference only, not as a substitute for an in-person consultation or professional medical advice. If you have any concerns or experience worsening symptoms, please seek medical attention promptly.