Lunotriquetral coalition and ulnar impaction syndrome: a pictorial essay

Davis, Derik L.

doi:10.1590/0100-3984.2017.0085

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Pictorial Essay • Radiol Bras 52 (2) • Mar-Apr 2019 • https://doi.org/10.1590/0100-3984.2017.0085 linkcopy

Lunotriquetral coalition and ulnar impaction syndrome: a pictorial essay

Coalizão lunato-triquetral e síndrome da impactação ulnar: ensaio iconográfico

Authorship SCIMAGO INSTITUTIONS RANKINGS

Lunotriquetral coalition and ulnar impaction syndrome are among the spectrum of pathology encountered at the medial wrist. The co-existence of these entities in the same wrist is rare. The purpose of this pictorial essay is to present the etiology, clinical course, imaging findings, and treatment of lunotriquetral coalition and ulnar impaction syndrome, and co-existing disease.

Keywords:
Lunotriquetral coalition; Ulnar impaction syndrome; Wrist

Authorship

person Derik L. Davis

schoolDepartment of Diagnostic Radiology & Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA.University of Maryland School of MedicineUSABaltimore, Maryland, USADepartment of Diagnostic Radiology & Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA.

0000-0002-7315-1825

Correspondence: Derik L. Davis, M.D. Department of Diagnostic Radiology & Nuclear Medicine, University of Maryland School of Medicine. 22 S. Greene Street, Baltimore, Maryland 21201, USA. Email:
ddavis7@umm.edu.

SCIMAGO INSTITUTIONS RANKINGS

Department of Diagnostic Radiology & Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA.University of Maryland School of MedicineUSABaltimore, Maryland, USADepartment of Diagnostic Radiology & Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA.

Figures

Figures (9)

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Figure 1 Lunotriquetral coalition Minnaar types 1, 2 and 3. A: Type 1 (arrow) is a fibrous syndesmosis between the lunate and triquetrum, in this case found incidentally in a patient presenting with acute distal radius and ulna fractures. B: Type 2 is incomplete bony coalition, as evidenced by a small residual lucent cleft in this case (arrow). C: Type 3 is complete bony coalition.

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Figure 2 Different examples of Minnaar type 4 lunotriquetral coalition. A: Lunotriquetral coalition (white arrow) accompanying by capitatotrapezoid coalition (black arrow). B: Multiple short metacarpal bones (asterisks) associated with lunotriquetral coalition.

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Figure 3 Positive ulnar variance. The ulnar head is distal to the articular surface of the radius (line). Prominent subchondral cystic changes (arrow) are associated with the ulnocarpal joint surface of the lunate in this patient.

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Figure 4 Negative and neutral ulnar variance. A: In negative ulnar variance, the ulnar head is proximal relative to the articular surface of the radius (line). B: In neutral ulnar variance, the radius and ulna are equal length (line).

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Figure 5 Symptomatic type 2 lunotriquetral coalition complicated by ulnar impaction syndrome requiring surgical management. A,B: Anteroposterior and lateral radiographs show acquired positive ulnar variance as the long term sequela of distal radius fracture malunion, with persistent chronic loss of radial length and dorsal tilt (arrow) following healing. C: Surgical resection of the distal ulna (arrow) was performed for operative management.

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Figure 6 Locations of bony pathology in ulnar impaction syndrome complicating lunotriquetral coalition. A: Posteroanterior radiograph shows positive ulnar variance, type 2 lunotriquetral coalition, and subchondral cysts at the ulnocarpal articular surface of the lunate (arrow). B: Coronal image of unenhanced computed tomography shows positive ulnar variance, type 3 lunotriquetral coalition, and subchondral cysts in the ulnar head (black arrow) and triquetrum (white arrow).

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Figure 7 Isolated type 3 lunotriquetral coalition complicated by ulnar impaction syndrome. Subtle sclerosis and subchondral cyst formation (short white arrow) is present in a central location along the ulnocarpal surface of the lunotriquetral coalition, in addition to more prominent cystic changes and central osteophyte formation at the ulnar head (black arrow). Linear chondrocalcinosis is centered in the ulnocarpal joint space (long white arrow).

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Figure 8 Syndrome-related lunotriquetral coalition complicated by ulnar impaction syndrome. A,B: Right and left anteroposterior radiographs of the wrists show type 4 lunotriquetral coalition with associated bony coalition of the entire distal carpal row bilaterally (asterisks). Subchondral cystic changes are present in the left ulnar head (white arrow) and the ulnocarpal aspect of the bilateral lunotriquetral coalitions (black arrows).

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Figure 9 Type 3 lunotriquetral coalition complicated by ulnar impaction syndrome on magnetic resonance imaging. A,B: Coronal T1-weighted and coronal STIR-weighted magnetic resonance images show bone marrow edema (short arrows) adjacent to a large subchondral cyst at the ulnar head, and a triangular fibrocartilage tear at the radial attachment (long arrow).

imageFigure 1 Lunotriquetral coalition Minnaar types 1, 2 and 3. A: Type 1 (arrow) is a fibrous syndesmosis between the lunate and triquetrum, in this case found incidentally in a patient presenting with acute distal radius and ulna fractures. B: Type 2 is incomplete bony coalition, as evidenced by a small residual lucent cleft in this case (arrow). C: Type 3 is complete bony coalition. open_in_new

imageFigure 2 Different examples of Minnaar type 4 lunotriquetral coalition. A: Lunotriquetral coalition (white arrow) accompanying by capitatotrapezoid coalition (black arrow). B: Multiple short metacarpal bones (asterisks) associated with lunotriquetral coalition. open_in_new

imageFigure 3 Positive ulnar variance. The ulnar head is distal to the articular surface of the radius (line). Prominent subchondral cystic changes (arrow) are associated with the ulnocarpal joint surface of the lunate in this patient. open_in_new

imageFigure 4 Negative and neutral ulnar variance. A: In negative ulnar variance, the ulnar head is proximal relative to the articular surface of the radius (line). B: In neutral ulnar variance, the radius and ulna are equal length (line). open_in_new

imageFigure 5 Symptomatic type 2 lunotriquetral coalition complicated by ulnar impaction syndrome requiring surgical management. A,B: Anteroposterior and lateral radiographs show acquired positive ulnar variance as the long term sequela of distal radius fracture malunion, with persistent chronic loss of radial length and dorsal tilt (arrow) following healing. C: Surgical resection of the distal ulna (arrow) was performed for operative management. open_in_new

imageFigure 6 Locations of bony pathology in ulnar impaction syndrome complicating lunotriquetral coalition. A: Posteroanterior radiograph shows positive ulnar variance, type 2 lunotriquetral coalition, and subchondral cysts at the ulnocarpal articular surface of the lunate (arrow). B: Coronal image of unenhanced computed tomography shows positive ulnar variance, type 3 lunotriquetral coalition, and subchondral cysts in the ulnar head (black arrow) and triquetrum (white arrow). open_in_new

imageFigure 7 Isolated type 3 lunotriquetral coalition complicated by ulnar impaction syndrome. Subtle sclerosis and subchondral cyst formation (short white arrow) is present in a central location along the ulnocarpal surface of the lunotriquetral coalition, in addition to more prominent cystic changes and central osteophyte formation at the ulnar head (black arrow). Linear chondrocalcinosis is centered in the ulnocarpal joint space (long white arrow). open_in_new

imageFigure 8 Syndrome-related lunotriquetral coalition complicated by ulnar impaction syndrome. A,B: Right and left anteroposterior radiographs of the wrists show type 4 lunotriquetral coalition with associated bony coalition of the entire distal carpal row bilaterally (asterisks). Subchondral cystic changes are present in the left ulnar head (white arrow) and the ulnocarpal aspect of the bilateral lunotriquetral coalitions (black arrows). open_in_new

imageFigure 9 Type 3 lunotriquetral coalition complicated by ulnar impaction syndrome on magnetic resonance imaging. A,B: Coronal T1-weighted and coronal STIR-weighted magnetic resonance images show bone marrow edema (short arrows) adjacent to a large subchondral cyst at the ulnar head, and a triangular fibrocartilage tear at the radial attachment (long arrow). open_in_new

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