Carpal Fusion-Plain Film

Young adult with pain after trivial fall shows carpal fusion possible isolated without any syndrome of proximal row, presumably involving lunatotriquetral (most common amongst the anomalies). Comparative xray of other hand and CT would help delineate it further

Teaching points by Dr MGK Murthy, Dr Sumer Sethi.

·         Fusion of carpal bones is misnomer as it is not true fusion and is absence of  joint cavitation and chondrification of joint inter zone

·         Leads to synostosis and seen only when  all carpal bones ossify

·         Incidence is 0.1% of population with  increase amongst the females(twice),  and Africans with family history

·         Usually bilateral with left more involved if unilateral

·         Usually asymptomatic but some like pisohammate could lead to pain

·         Reduced movement leads to compensated movements at other  inter carpal joints and premature stress related  degeneration

·         Congenital fusion are two types –isolated ones show usually two bones of the same row

·         Syndrome associated  ones like Ellis van Creveld syndrome, Osteochondritis dissecans, foetal alcohol syndrome, symphalangia, diastrophic dwarfism, gonadal dysgenesis, and Poland syndrome, are quite often multiple