Year : 2006 | Volume
: 16 | Issue : 4 | Page : 585--586
Bilateral coalition of capitate & trapezoid a very rare case
JPS Walia, A Singh, AK Walia, D Kumar
Department of Orthopaedics, Govt. Medical College & Rajindra Hospital, Patiala-147001, Punjab, India
70-E, Police Lines, Patiala-147001, Punjab
|How to cite this article:|
Walia J, Singh A, Walia A K, Kumar D. Bilateral coalition of capitate & trapezoid a very rare case.Indian J Radiol Imaging 2006;16:585-586
|How to cite this URL:|
Walia J, Singh A, Walia A K, Kumar D. Bilateral coalition of capitate & trapezoid a very rare case. Indian J Radiol Imaging [serial online] 2006 [cited 2020 Jan 19 ];16:585-586
Available from: http://www.ijri.org/text.asp?2006/16/4/585/32275
A young National level Boxer player attended the OPD, Orthopaedic Department of Rajindra Hospital, Patiala.
He had chief complaint of sudden sharp pain in both wrists whenever he punched hard during exercise. After taking rest, pain used to subside. Pain appeared only when he did hard punching exercise. No H/o swelling, no deformity & no H/o difficulty in movement of both wrists. No H/o any injury in the past. No H/o any problem in other joints of body.
On examination :- Both wrists appeared normal. No swelling or deformity. No area of localised tenderness in both wrists, and movements were normal. Physical examination of both upper limbs was normal.
Routine examination of blood & urine with in normal limits.
Roentgenogram :- X-ray of both wrists showed coalition of capitate and trapezoid. Well defined Trabecular pattern seen between both carpals. At the site of fusion no articular area seen. Other carpals, metacarpals seen normal.
Carpal fusions are relatively common asymptomatic abnormalities, that occur as normal variation in about 0.1% of the population. Triquetro-lunate fusions are most common but capitatotrapezoid fusion is an isolated case. It is important to note that isolated fusion is usually present as involvement of same carpal row, while syndrome related carpal fusion affect bone in different rows (Resnick D). Acquired carpal fusions are most commonly seen in juvenile rheumatoid arthritis. Itrogenic/surgical induced carpal fusions are commonly used as treatment modality for Keinbock's disease (Viola RW).
Congenital carpal coalitions are implied to develop from failure of segmentation of primitive cartilaginous canal. Carpal coalitions have been noted as a part of foetal-alcohol syndrome (McCredie J). Massive carpal fusions, between bones of the proximal and distal carpal rows or between the carpal bone and radius or ulna are generally associated with additional malformation. These include tarsal coalitions or one of the congenital syndromes such as acro- cephalosyndactyly syndrome, arthrogryposis, diastrophic dwarfism, Ellis-vam Creveld syndrome, hand-foot-uterus syndrome, Holt-Oram syndrome, Turner syndrome or symphalangism (Weinzweig J.)
Acquired carpal fusion is differentiated from congenital fusion radiologically in roentgenogram. Continuous trabeculae traced from one carpal to next signify a fusion. Intraosseous cysts adjacent to area of coalition are usually seen in acquired ankylosis due to infection, trauma & arthritis.
Congenital carpal fusions are almost complete. Shallow grooves may demarcate the line of fusion. Radiologically there is normal trabecular pattern and no joint cavity within fused bones (Choudhary R).
Most cases of congenital isolated carpal coalition are asymptomatic. Partial coalition and cystic changes have more incidence of pain. Fused carpal bones carry a definite risk of fracture. Patient with carpal fusions may poorly tolerate stress loading or trauma, resulting in symptomatic state similar to degenerative arthritis or pseudoarthrosis. Increased demand on joint especially in high activity levels like in sports persons, may lead to progressive stress leading to early degenerative arthritis. There is also risk of fracture or progressive neuropathy (Stabler A). Sporting activities involving high demand on wrist loading & movement (like Boxers) may lead to early presentation.
Treatment is rarely required for asymptomatic cases of carpal fusions.
Intervention if at all needed, should be restricted to the cases with secondary sequelae including arthritis, neuropathy or fracture. Modalities required include immobilisation for fractures, decompression for neuropathy and carpal excision (Isolated/Row) for severe arthritis. Treatment is usually symptom based
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