Lunotriquetrale Koalition

Lunotriquetral coalition is the most common type of carpal coalition and represents a congenital fusion of the lunate and triquetral bones of the carpus.

Epidemiology

Lunotriquetral coalition is the most common type of carpal coalition with a prevalence of 0.1%. It is more common in females (F:M = 2:1) and African Americans.

Clinical presentation

Whilst osseous coalitions of the lunate and the triquetrum are known to be asymptomatic, fibrocartilaginous lunotriquetral coalitions can present as an uncommon cause of ulnar-sided wrist pain often due to the pseudarthrosis or a post-traumatic disruption .

Pathology

  • coalition may be fibrous, cartilaginous or osseous
  • commonly bilateral

Carpal coalitions can follow an autosomal dominant route of inheritance

Classification

de Villiers classified lunotriquetral coalition into four types :

  • incomplete (or fibrocartilaginous) fusion - resembles a pseudoarthrosis
  • incomplete osseous fusion 
  • complete osseous fusion
  • complete osseous fusion with other carpal abnormalities
  • Radiographic features

    Plain radiograph
    • coalition of the lunate and triquetrum
    • may be accompanied by a widened scapholunate interval  

    Treatment and prognosis

    Most commonly an incidental finding. May occasionally be the cause of chronic wrist pain (especially in types 1 and 2 ) and, of course, can be fractured.

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