Wrist pain after a fall.
The patient complained of wrist pain after a fall. A conventional radiograph was performed (figure 1a). Lunotriquetral coalition was detected as an incidental finding. We illustrate several examples of carpal coalitions and show the most typical radiological findings.
Carpal coalitions are relatively common anomalies in which two or more carpal bones fail to segment during development, resulting in a congenital fusion that may be bony, cartilaginous, or fibrous [1]. Carpal coalitions usually appear as an isolated phenomenon, although they may occur as a part of congenital malformative syndromes. As a rule, isolated fusions involve bones in the same carpal row, whereas syndrome-related or postinfectious coalitions involve bones in adjacents rows [2]. Idiopathic coalitions are more common in females and African-Americans. The most common site of the isolated fusion is between the triquetrum and the lunate bones (figure 1), which is bilateral in approximately 60 per cent of patients [3]. The spectrum of lunotriquetral coalitions was classified in four types by Minaar [2]:
- type I: proximal fibrous or cartilaginous coalition;
- type II: incomplete bony fusion with distal notch;
- type III: complete bony fusion;
- type IV: complete bony fusion with other carpal anomalies.
A common radiological feature is the widening of the scapholunate interosseous joint space, although the scapholunate interosseous ligament is intact.
The second most frequent coalition is between capitate and hamate bones (figure 2).
Other rare fusions have also been described, such as capitate-trapezoid fusion (figure 3), trapezium-trapezoid fusion, and pisiform-hamate fusion.
Although they do not commonly produce symptoms, pain has been described in association with partial fusion and cystic changes in the adjacent bones. Massive carpal fusion, coalitions between bones of different carpal rows, or coalitions between carpal bones and distal extremities of the ulna or radius appear in association with other malformations as part of Holt-Oram syndrome, Turner syndrom, acrocephalosyndactyly syndromes, arthrogryposis or symphalangism [3].
Carpal coalition
Based on the provided X-ray images and clinical information, in the carpal bones distal to the radioulnar joint of the left (or right) wrist, we can observe:
This is the most common type of congenital carpal fusion, related to incomplete separation of the carpal bones during development. It is often asymptomatic, but some patients may experience wrist pain after trauma or repetitive strain.
Although the current X-ray does not show obvious signs of fracture, ligamentous injuries (such as tears of the scapholunate or lunotriquetral ligaments) should be ruled out. In clinical practice, acute wrist pain after trauma calls for evaluation of possible ligamentous injury or an occult fracture not clearly visible on X-rays.
In middle-aged and older patients, wrist pain also necessitates consideration of degenerative arthritis or other joint conditions. If chronic pain recurs, MRI or CT might be warranted for further assessment.
Considering the patient’s age (48 years), gender (male), acute presentation with wrist pain following a fall, and the X-ray findings of congenital fusion between the triquetrum and lunate, the most likely diagnosis is: Congenital Lunotriquetral Coalition with Post-Traumatic Symptoms.
If there is any suspicion of concurrent ligamentous injury or occult fracture, an MRI or CT scan can be performed to confirm the diagnosis.
In most cases, a lunotriquetral coalition itself requires no special treatment. If there is no significant functional impairment or severe pain, conservative management is often sufficient. If there is confirmed trauma, ligamentous injury, or persistent pain, targeted interventions may be necessary.
For persistent pain or significant structural damage (ligament rupture, marked degenerative changes, or joint instability), arthroscopic evaluation or surgical intervention may be considered, such as ligament repair or joint fusion. Preoperative planning should balance the patient’s functional needs and potential risks.
Note: If severe or persistent pain and swelling occur during exercise, discontinue and consult a specialist or physical therapist.
This report is a reference analysis based on the current information provided (images and history) and does not replace an in-person consultation or professional medical advice. For specific diagnosis and treatment, please consult orthopedic or radiology specialists.
Carpal coalition
