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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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