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Bilateral Ulnar-Sided Wrist Pain due to Pisiform-Hamate Coalition. Case Rep Orthop 2019; 2019:5891972. [PMID: 31885981 PMCID: PMC6900954 DOI: 10.1155/2019/5891972] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 11/19/2019] [Indexed: 11/19/2022] Open
Abstract
Coalition between the pisiform and the hamate is a rare congenital anomaly, often presenting as an asymptomatic incidental finding on radiographs. In some cases, it may become symptomatic, typically after trauma. We present a 13-year-old patient, with no history of trauma, presenting a bilateral painful coalition of the pisiform and hamate. Both of which were treated with excision of the pisiform resulting in complete pain relief. Pisiform-hamate coalition is a rare condition, which can become symptomatic even without any trauma or overuse activity, and is an important differential diagnosis in ulnar-sided wrist pain.
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Hamate-pisiform coalition complicated by fracture in a pediatric patient. Radiol Case Rep 2018; 13:1163-1165. [PMID: 30233751 PMCID: PMC6138946 DOI: 10.1016/j.radcr.2018.07.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 07/13/2018] [Accepted: 07/16/2018] [Indexed: 11/23/2022] Open
Abstract
Coalition of the carpal bones is a relatively uncommon anatomic anomaly. The majority of carpal coalitions occur between the lunate and triquetrum. There are rare reports of coalition involving the hamate and pisiform. We report a case of a previously asymptomatic male who sustained minor trauma and was found to have hamate-pisiform coalition complicated by a minimally displaced pisiform fracture.
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3
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Affiliation(s)
- Farouk Dargai
- 1 Department of Orthopaedic Surgery, CHU Félix Guyon, La Réunion, Saint Denis, France
| | - Rani Kassir
- 2 Department of Pediatric Surgery, CHU Félix Guyon, La Réunion, Saint Denis, France
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Cortese J, Soubeyrand M, Razakamanantsoa L, Bellin MF, Creze M. Hamate and pisiform coalition: a case report and introduction to the carpal C-sign on lateral radiograph. Skeletal Radiol 2017; 46:693-699. [PMID: 28229185 DOI: 10.1007/s00256-017-2593-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 01/05/2017] [Accepted: 02/07/2017] [Indexed: 02/02/2023]
Abstract
Hamate-pisiform coalition is an exceptional form of carpal coalition. Case reports are essential to gain a better understanding of this variant. We report a case of congenital bilateral hamate-pisiform coalition in a 20-year-old male discovered in the context of a right wrist trauma. Radiographs also revealed a bilateral scapholunate diastasis. Clinical examination and radiological findings suggested that the right wrist scapholunate diastasis was related to scapholunate instability. Left wrist scapholunate diastasis could be related to (1) a pathological feature or (2) a normal variant associated with hamate-pisiform coalition. Lateral radiographs showed a volar C-shaped osseous bridge corresponding to the coalition. We associated it with a new sign: the "carpal C-sign". Computed tomography with three-dimensional reconstruction provides helpful information about the type of coalition (osseous versus non-osseous) and excludes potential fracture. We discuss the specific embryologic features of the hamate-pisiform coalition, as well as its prevalence, radiographic classification, clinical significance, and treatment.
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Affiliation(s)
- Jonathan Cortese
- Radiology Department, Hôpital Bicêtre, 78 rue du Général Leclerc, 94266, Le Kremlin-Bicetre, France.
| | - Marc Soubeyrand
- Orthopaedic Department, Hôpital Bicêtre, 78 rue du Général Leclerc, 94266, Le Kremlin-Bicetre, France
| | - Leo Razakamanantsoa
- Radiology Department, Hôpital Bicêtre, 78 rue du Général Leclerc, 94266, Le Kremlin-Bicetre, France
| | - Marie-France Bellin
- Radiology Department, Hôpital Bicêtre, 78 rue du Général Leclerc, 94266, Le Kremlin-Bicetre, France
| | - Maud Creze
- Radiology Department, Hôpital Bicêtre, 78 rue du Général Leclerc, 94266, Le Kremlin-Bicetre, France
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van Hoorn BT, Pong T, van Leeuwen WF, Ring D. Carpal Coalitions on Radiographs: Prevalence and Association With Ordering Indication. J Hand Surg Am 2017; 42:329-334. [PMID: 28284456 DOI: 10.1016/j.jhsa.2017.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 02/01/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE Carpal coalitions are common and usually incidental to the indication for wrist radiographs. It is not clear if, or when, carpal coalitions cause pain. The aim of this study was to assess the prevalence of incidental carpal coalitions by evaluating radiographs taken for various indications and to test the association of demographic variables and ordering indications with the finding of a carpal coalition. METHODS We reviewed 1,119 posteroanterior wrist radiographs for the presence of carpal coalition. We used bivariate and multivariate analyses to assess demographic factors for their independent associations with the presence of carpal coalitions and to compare the difference in the prevalence of carpal coalitions between radiographs obtained to evaluate traumatic wrist pain (623 wrists), nontraumatic wrist pain (175 wrists), and other reasons (321 wrists). RESULTS Radiographs of 98 out of 1,119 patients (8.8%) showed a carpal coalition. Carpal coalitions were equally likely on radiographs obtained for traumatic wrist pain and nontraumatic wrist pain. Patients with no wrist trauma or wrist pain were less likely to have a carpal coalition on their radiograph. CONCLUSIONS We consider carpal coalitions an unlikely cause of wrist pain. The lower prevalence in radiographs obtained for causes other than wrist trauma or wrist pain remains unexplained, although it may be spurious. In the evaluation of a patient with nonspecific wrist pain, clinicians should be careful ascribing symptoms to anatomical variations on radiographs. These incidental findings should not usually affect management. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnostic III.
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Affiliation(s)
- Bastiaan T van Hoorn
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Taylor Pong
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Wouter F van Leeuwen
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, TX.
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Abstract
BACKGROUND Carpal coalitions (CCs) result from the failure of segmentation of the carpal anlage in early development. In the adult population, CC is usually described as an asymptomatic radiographic finding. Data on CC in the pediatric population are limited. This study examines the prevalence of CC in the pediatric population and characterizes the presentation and associated musculoskeletal conditions. METHODS We used a cross-sectional design to assess data collected from all patients seen in our institution and associated facilities from August 2004 through February 2013. In total, 20,929 patients had an upper extremity x-ray taken that included the wrist. A natural language software recognition program for key words identified 104 patients with CC. Period prevalence and demographic and radiographic data were estimated using frequency and percentages. RESULTS The period prevalence of CC in this population was 5:1000. The initial age at the radiologic CC presentation varies between types. The most common CC (luno-triquetral, 69.2%) had a mean age at presentation of 12 y 11 mo. The second most frequent CC (capito-hamate, 17.2%) had a mean age at presentation of 8 y 2 mo. CCs were more prevalent among African American children; however, capito-hamate coalitions (the second most common coalition) were more often observed in whites. CC was symptomatic in 2 patients. Thirty-nine patients had associated conditions such as skeletal dysplasia and limb deformity, and most of these patients were diagnosed with capito-hamate coalitions. CONCLUSIONS The period prevalence of CC in this pediatric population is 5:1000. Similar prevalence has been reported in other studies. Although the prevalence of CC is comparable by sex, it is most common among African American children. The most common CC is luno-triquetral followed by capito-hamate. Capito-hamate coalitions were more common among patients with associated conditions and were diagnosed at a younger age relative to other subtypes in our group. LEVEL OF EVIDENCE Level IV-prognostic case series.
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Abstract
Background: Carpal coalition and metacarpal synostosis are uncommon congenital anomalies of the carpus and hand. Methods: A comprehensive review of the literature was performed to help guide surgical and non-surgical treatment of carpal coalition and metacarpal synostosis. Results: The embryology, epidemiology, medical and surgical management, and associated outcomes are detailed. Conclusions: Most patients with these disorders will likely benefit from conservative measures. Surgery should be considered in patients with pain and limitations in wrist and hand function.
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Affiliation(s)
- Michael B. Gottschalk
- Emory School of Medicine, Department of Orthopaedics, Atlanta, GA, USA
- Michael B. Gottschalk, Assistant Professor Hand and Upper Extremity, Director of Clinical Research, 4555 N Shallowford Road Ste 100, Dunwoody, GA 30338, USA.
| | - Maxim Danilevich
- University of Texas Medical Branch School of Medicine, Galveston, USA
| | - Hilton P. Gottschalk
- Dell Children’s Medical Center, Austin, TX, USA
- Central Texas Pediatric Orthopedics, Austin, TX, USA
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Radiolunate coalition: a case report and literature review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2012; 22 Suppl 1:79-83. [PMID: 26662754 DOI: 10.1007/s00590-011-0863-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2011] [Accepted: 08/25/2011] [Indexed: 10/17/2022]
Abstract
Radiolunate coalition is a very rare entity and was never reported before. we herein describe a case of congenital non-syndromic radiolunate coalition in a 30 year old male with a brief review of literature. we have also suggested a modification to Minaar's classification for carpal coalition.
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Abstract
Osseous injuries to the ulnar aspect of the carpus are increasing in frequency because of greater participation in sporting activities. Hamate body fractures are subdivided into coronal, sagittal oblique, proximal pole, and medial tuberosity fractures. Successful treatment of coronal fractures requires identification and treatment of associated disruption or instability of the ulnar 2 carpometacarpal joints. Displaced hamate hook fractures are optimally treated with early excision to avoid sequelae such as flexor tendon and nerve injury, and to allow early return to activity. Undisplaced pisiform fractures are managed nonoperatively, whereas displaced fractures and nonunions are treated by simple excision.
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10
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Abstract
Congenital fusions of the carpal bones are rare anomalies, which occur in less than 1% of the population. This article describes a congenital pisiform hamate coalition which became symptomatic when caused by a trauma. The condition was successfully treated with the resection of the synchondrosis, autogenous bone graft, and screw stabilization.
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11
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Burnett SE. Hamate-pisiform coalition: morphology, clinical significance, and a simplified classification scheme for carpal coalition. Clin Anat 2010; 24:188-96. [PMID: 21322040 DOI: 10.1002/ca.21086] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Revised: 09/20/2010] [Accepted: 09/24/2010] [Indexed: 11/06/2022]
Abstract
Hamate-pisiform coalition is characterized by the abnormal union of the pisiform bone and hamulus of the hamate. Because most reported cases are isolated, and literature on the subject is sparse, relatively little is known about this condition and its clinical significance. The purpose of this report is to discuss the occurrence, morphology, and frequency of hamate-pisiform coalition identified in a skeletal sample of native South Africans, and to conduct a metaanalysis of all known cases in order to clarify the sex distribution, laterality, form, and clinical significance of this condition. Five new cases (three male, two female) of hamate-pisiform coalition were identified in 527 native South Africans. Results indicate that hamate-pisiform coalition is infrequent (0.76%) but may be more likely encountered in individuals of African ancestry. Morphologically, non-osseous examples ranged in appearance from minor expressions involving pitting of an expanded hamulus base, to a variably pitted articulation between an elongated pisiform and hamulus. Osseous union between the two bones tends to extend beyond the hamulus base to adjacent areas of the hamate. Cases involving osseous union appear predisposed to fracture while ulnar neuropathy is significantly more frequent in individuals exhibiting non-osseous coalition. As both non-osseous and osseous cases can have clinical significance, awareness of the variable manifestations of this condition is necessary for hand specialists. A simplified classification system is suggested to more consistently characterize carpal coalitions.
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Affiliation(s)
- Scott E Burnett
- Comparative Cultures Collegium, Eckerd College, St. Petersburg, Florida 33711, USA.
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Kawamura K, Yajima H, Takakura Y. Pisiform and hamate coalition: case report and review of literature. ACTA ACUST UNITED AC 2005; 10:101-4. [PMID: 16106510 DOI: 10.1142/s0218810405002486] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2004] [Accepted: 01/25/2005] [Indexed: 11/18/2022]
Abstract
Pisiform and hamate coalition is a rare anomaly of the carpal bones; a symptomatic case is an especially rare condition. We report a case of symptomatic pisiform and hamate coalition in a 15-year-old Japanese male. The literature of pisiform and hamate coalition is reviewed.
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Affiliation(s)
- Kenji Kawamura
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Japan
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Boya H, Ozcan O, Araç S, Tandoğan R. Incomplete scapholunate and trapeziotrapezoid coalitions with an accessory carpal bone. J Orthop Sci 2005; 10:99-102. [PMID: 15666131 DOI: 10.1007/s00776-004-0853-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2004] [Accepted: 10/01/2004] [Indexed: 10/25/2022]
Abstract
Coalitions of the carpal bones associated with accessory carpal bones are relatively uncommon. We present a case of scapholunate and trapeziotrapezoid incomplete coalition with a dorsally situated accessory bone between trapezium and trapezoideum. X-ray, computed tomography, and magnetic resonance imaging findings of the patient are discussed in light of the pertinent literature.
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Affiliation(s)
- Hakan Boya
- Başkent University, Zübeyde Hanim Uygulama ve Araştirma Merkezi, 6371 Sokak, No.34, Bostanli, Karşiyaka, Izmir, Turkey
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Abstract
The authors report a symptomatic case of pisiforme hamate coalition in a young woman. The resection of the synchondrosis allowed the complete resolution of the pain. The pisiforme hamate fusion is an exceptional deformity and it is confirmed by the revue of the Literature.
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Affiliation(s)
- G Robert
- Cabinet Icare, 467, avenue du Maréchal-Leclerc, 59155, Faches-Thumesnil, France
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15
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El-Morshidy AF, Rabia F, Mukaimi A. Bilateral asymptomatic pisiform and hamate coalition--a case report. HAND SURGERY : AN INTERNATIONAL JOURNAL DEVOTED TO HAND AND UPPER LIMB SURGERY AND RELATED RESEARCH : JOURNAL OF THE ASIA-PACIFIC FEDERATION OF SOCIETIES FOR SURGERY OF THE HAND 2000; 5:57-60. [PMID: 11089189 DOI: 10.1142/s0218810400000168] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/1999] [Accepted: 10/14/1999] [Indexed: 11/18/2022]
Abstract
Abnormal anatomy of carpal bones is uncommon. We report on a multitrauma patient that, was initially misdiagnosed as scaphoid dislocation, which later was proven to be pisiform hamate coalition.
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Affiliation(s)
- A F El-Morshidy
- Orthopaedic Department, AL-Razi Orthopaedic Hospital, P.O. Box 4235, Safat. 13043, Kuwait
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Richterman IE, Kozin SH. Symptomatic pisiform hamate synchondrosis: a case report and review of the literature. J Hand Surg Am 1996; 21:311-3. [PMID: 8683075 DOI: 10.1016/s0363-5023(96)80129-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- I E Richterman
- Department of Orthoedic Surgery. Albert Eintein Medical Center, Philadelphia, PA, USA
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Rahman ME, Ishikawa H, Watanabe Y, Endo A. Carpal and tarsal bone anomalies in mice induced by maternal treatment of Ara-C. Reprod Toxicol 1994; 8:41-7. [PMID: 8186622 DOI: 10.1016/0890-6238(94)90065-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Pregnant mice of the Jcl:ICR strain were injected intraperitoneally with a single dose of 5 mg/kg of cytosine arabinoside (Ara-C) on dg 10.5. Skeletal changes of the forepaw and hindpaw were evaluated in the offspring on the 15th or 24th postnatal day. Various anomalies of carpal and tarsal bones such as fusion, absence, and deformation occurred at high incidence at a dose that produced digital anomalies. Almost all newborns with Ara-C-induced digital anomalies (oligodactyly or polydactyly) had anomalies of carpal or tarsal bones in the particular paw, while anomalies of carpal or tarsal bones could occur in the presence or absence of digital anomalies. Carpal and tarsal bone anomalies may become a sensitive and novel parameter of limb development in the postnatal teratogen testing system.
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Affiliation(s)
- M E Rahman
- Department of Hygiene and Preventive Medicine, Yamagata University School of Medicine, Japan
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Abstract
Two cases of pisiform-hamate coalition with compression of the ulnar nerve at the wrist are reported. Pisiform-hamate coalition is a rare entity previously thought to be exclusive to West Africans and without clinical significance. These cases occurred in white patients. This is the first description of a carpal coalition resulting in ulnar neuropathy at the wrist.
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