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Surgical Treatment of Symptomatic Congenital Lunotriquetral Synchondrosis: A Report of Four Cases
Richard M. Hinds, MD1; Daniel Tordjman, MD2; Mohamed Barry, MD3; S. Steven Yang, MD, MPH1
1NYU Hospital for Joint Diseases, New York, NY, 2Georges-Pompidou European Hospital (HEGP), Paris, France, 3Wayne State University School of Medicine, Detroit Medical Center, Detroit, MI

Introduction: Lunotriquetral (LT) synchondrosis is an uncommon variant of congenital LT coalition. Unlike complete LT coalitions, this incomplete pseudoarthrosis-like coalition can become symptomatic. The purpose of this study was to present the clinical outcomes of symptomatic LT synchondrosis patients following LT fusion using a second generation headless compression screw and distal radius cancellous autograft.
Methods: A retrospective review was performed to identify all patients with radiographic and magnetic resonance imaging confirmed Minnaar Type I LT synchondrosis. Patients with persistent symptoms despite of a trial of conservative management met indications for LT fusion and were included in this analysis. Fusion was performed using a Acutrak II headless compression screw (Acumed; Hillsboro, OR) and distal radius cancellous autograft. Preoperative and postoperative range of motion, grip strength measurements, and VAS pain scores were compared.
Results: Four patients met the inclusion criteria of this study. Mean patient age was 34 years (range, 28-41) with a mean clinical follow-up of 17 months (range, 13-22). Final postoperative examination demonstrated a mean wrist flexion of 53, wrist extension of 54, ulnar deviation of 39, radial deviation of 18, and grip strength of 30 kg. These results indicated improvements from preoperative measurements of 7% for wrist flexion, 16% for wrist extension, 28% for ulnar deviation, 0% for radial deviation, and 27% for grip strength. Mean VAS pain scores improved from 6 to 1. Radiographic fusion and symptomatic relief was achieved in all four cases.
Conclusion: Fusion of LT synchondroses utilizing a headless compression screw and distal radius cancellous autograft may result in a lower non-union rate than traditional techniques and offers excellent pain relief without functional compromise. Although further investigation and a larger study cohort are needed to identify any long-term complications or surgical sequela, our findings demonstrate the successful utilization of this fusion technique in a small cohort of patients with symptomatic LT synchondroses.


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