Validation of radiographic assessment of radiocarpal (mal)alignment in a normal population.

We measured radiocarpal alignment in 150 standard lateral radiographs of normal wrists. In 84% of the cases, the lines of the long axis of the capitate and radius did not cross within the carpus.

A Changing Landscape in the Surgical Management of Wrist Arthritis: An Analysis of National Trends From 2009 to 2019.

PURPOSE: The purpose of this study was to analyze the trends in the annual volume and incidence of proximal row carpectomy (PRC), four-corner fusion (4CF), total wrist arthrodesis (TWF), and total wrist arthroplasty (TWA) from 2009 to 2019 in the United States. METHODS: The IBM Watson Health MarketScan databases were queried to identify annual case volumes for PRC, 4CF, TWF, and TWA from 2009 to 2019. The annual incidence of these procedures was then calculated based on the population estimates from the US Census Bureau. Trends in annual volume and incidence over the study period were evaluated using regression line analysis. Further subgroup analysis was conducted based on age and region. RESULTS: From 2009 to 2019, the total case volumes for the four procedures increased by 3.4%, but the incidence decreased by 2.8%. However, PRC case volume and incidence trends significantly increased (38.2% and 29.7%, respectively), whereas 4CF remained constant. Conversely, the case volume and incidence of TWA significantly decreased (-52.2% and -54.5%, respectively), whereas TWF remained constant. When stratified by age, all four procedures decreased in the <45-year-old cohort (combined -35.1%) significantly for 4CF, TWF, and TWA. TWA decreased significantly in the <45-year-old and 45- to 65-year-old cohorts (53.6% and 63.2%, respectively). For age >65 years, the total case incidence increased by 98.9%, including a significant positive trend in TWF (175%). CONCLUSIONS: Surgical management of wrist arthritis remains a controversial issue. However, PRC has gained recent support in the literature, and our results reflect this shift, even for the <45-year-old cohort. Furthermore, TWA declined, despite reports of positive early outcomes for fourth-generation implants. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II.

Replacement of a destroyed scaphoimodelled prosthesis.

Preiser disease is a rare condition where ischaemia and necrosis of the scaphoid bone occurs without previous fracture. A female patient in her 30s presented with severe right wrist pain caused by Preiser disease. Initially, she was treated by a pedicled vascularised bone graft, but unsuccessfully. Four years after the initial diagnosis, the affected scaphoid was replaced by a 3D modelled prosthesis. Three years after the operation, the patient had significant pain reduction, good wrist function and grip strength. Final X-rays demonstrated no signs of dislocation of the implant or signs of periprosthetic arthritis. Studies have shown that once scaphoid non-union advanced collapse occurs, treatment should consist of either a proximal row carpectomy or scaphoidectomy and four corner fusion. In our case, despite collapse and previous surgery, replacement of the single affected bone by a 3D modelled prosthesis lead to good return of function.

[Technique Optimization of Interposition Arthroplasty During Proximal Row Carpectomy with Regard to the Vascularity of the Capsule in Carpal Joint: Cadaverous Study]. / Optimalizace techniky interpozicní artroplastiky pri proximální karpektomii s ohledem na vaskularizaci dorzální kapsuly karpu: kadaverózní studie.

PURPOSE OF THE STUDY The study aimed to propose an optimal based fl ap creation with the view to ensure long-term survival of the interposition arthroplasty. MATERIAL AND METHODS A total of 28 dorsal wrist capsules were collected from 16 cadavers (with age range at death 18 to 80 years, with no visible wrist pathology). Altogether 112 histological specimens were obtained from these 28 samples. Post-hoc Dunn's tests were used to analyse the percentage of vascularisation of individual sides of the dorsal capsule (circumference and area) at the 0.05 level of signifi cance. Spearmann's correlation analysis was used to assess the effect of age on vascularization of the dorsal wrist capsule. In cadavers in whom both capsules were collected, the limbs were compared. For the sake of comparison, the Wilcoxon matched pairs test was used. RESULTS Regarding statistical signifi cance, the largest share of the total circumference and area of the measured vessels of the dorsal capsule is constituted by the distal side (35.2% of the circumference and 30.9% of the area). The blood supply of the dorsal capsule received on the ulnar side is the lowest (12.9% of the circumference and 17.6% of the area). There was no signifi cant effect of age on vascularization of the dorsal wrist capsule confi rmed. Also, the comparison of vascularization of both limbs from a single cadaver did not yield any statistically signifi cant results. DISCUSSION Proximal row carpectomy is a long-established surgical technique used to manage the degenerative changes in the wrist. Our results showed the best vascularization on the distal and radial sides of the dorsal wrist capsule. In this light, the distally-based fl ap or the fl ap described by Berger, which respects the clinically important ligaments, appear to be the least invasive and help maintain the future stability of the wrist. CONCLUSIONS In clinical practice, we advise that a radially-based fl ap according to Berger is created and the distal side of the dorsal capsule, the most vascularized portion based on our results, is preserved as much as possible. The fl ap created in this manner also preserves the important carpal ligaments and appears to the authors of this study to be the most benefi cial, also with respect to the presence of the largest arteries, contrary to the distal side. Another option is to use a distally-based fl ap for interposition arthroplasty. Key words: interposition arthroplasty, proximal row carpectomy, vascularization, degenerative changes, wrist.

Carpal dislocations.

Carpal dislocations result from sequential disruption of the complex relationship between the bones and ligaments of the wrist. Injuries to the carpus occur via predictable mechanisms, an understanding of which is critical to identify and treat these frequently missed patterns of injury and to avoid the sequela of chronic instability. Lunate dislocations are by far the most common, but isolated dislocation of other carpal bones can also occur. Open reduction and internal fixation still remains the gold standard for treatment regardless of the debate around the specific approaches. These high-energy injuries are associated with significant long-term morbidity even when identified promptly and appropriately treated. This review will focus on the evaluation and management of common forms of carpal dislocations.

MDCT evaluation of distal radius fractures and their association with carpal and distal ulnar fractures.

PURPOSE: The purpose of this study was to evaluate the characteristics of distal radius fractures (DRFs) in patients undergoing multi-detector computed tomography (MDCT) and their association with carpal and distal ulnar fractures. METHODS: This retrospective study analyzed 120 patients, who underwent MDCT for evaluation of DRFs. Two radiologists independently evaluated the data for various fracture characteristics and for associated carpal and distal ulnar fractures. RESULTS: Out of 120 DRFs, 74 were complete articular, 40 were partial articular and only 6 were extra-articular. Displacement was present in 99 fractures and intra-articular step off was present in 73 fractures. A total of 81 carpal bone fractures were identified in 46 (38.3%) patients, with more than one carpal bone fracture in 21 patients. Distal ulnar fractures were detected in 79 patients (65.8%), out of which 67 involved the ulnar styloid. DRFs with intra-articular step off were more frequently associated with carpal bone fracture (p value: 0.021), while displaced DRFs were more frequently associated with distal ulnar fracture (p value <0.001). Interobserver agreement for detection of carpal bone fractures (κ = 0.807) and distal ulnar fractures (κ = 0.923) was excellent. CONCLUSION: Majority of DRFs in patients referred for MDCT were complete articular with high incidence of displacement and intra-articular step off. Associated carpal bone and distal ulna fractures were not uncommon.

Association of ulnar variance with three-dimensional carpal alignment and demographics in asymptomatic volunteers.

BACKGROUND: Several carpal pathologies are considered to be related to ulnar variance. Recently, computer-aided computed tomography (CT) analysis software was introduced to quantify three-dimensional (3D) carpal alignment with high accuracy and reliability. PURPOSE: To determine the association of ulnar variance with 3D carpal alignment and demographics. MATERIAL AND METHODS: A wrist of 121 asymptomatic volunteers (69 men, 52 women; mean age = 38 ± 10.4 years) was imaged in the neutral wrist position with cone-beam CT. Computer-aided CT analysis software (Bonelogic), based on segmentation and numerical modelling, was used to define ulnar variance and standardized 3D axes for all carpal bones. The association of ulnar variance with 3D carpal alignment, age of the volunteer, and side and dominance of the imaged wrist was assessed. RESULTS: The mean ulnar variance was -1.6 ± 1.5 mm (range = -5.3 to 2.4 mm). The mean ulnar variance was -1.9 mm and -1.1 mm in men and women (P = 0.007), respectively. Of the imaged 121 wrists, 18 (15%) had positive and 103 (85%) negative ulnar variance. There was no association between ulnar variance and any of the radio- or intercarpal angle values in either the sagittal or coronal plane (ρ = -0.16…0.17, r = -0.13….0.12). The ulnar variance showed no association with side (P = 0.51) or dominance (P = 0.27) of the imaged wrist. CONCLUSION: 3D carpal alignment is not affected by ulnar variance. The association of ulnar variance with sex may in part explain the difference in reported prevalence of some carpal pathologies, such as ulnar impaction syndrome and Kienböck's disease.

The accuracy of Cameriere methods in Turkish children: chronological age estimation using developing teeth and carpals and epiphyses of the ulna and radius.

The aim of the present study was to develop a specific formula by measuring the developing teeth, carpal bones, and epiphyses of the ulna and radius to determine the chronological age in Turkish children. The left developing permanent mandibular teeth were evaluated, and the number of teeth with closed apex was recorded. The distance between the inner sides of open apex/apices was measured by using the ImageJ program and divided by the tooth length. The sum of the normalized open apices was also calculated. The carpal area (Ca), covering the epiphyses of ulna and radius and the carpal bones, was measured on the X-rays of left hand. The areas of each carpal bone and epiphyses of the ulna and radius were measured, and these measurements were added together to obtain the bone area (Bo). The Bo/Ca ratio between the total area of carpal bones and the carpal area was calculated to normalize the measurements. The accuracy of the equations formulated by Cameriere was evaluated, and a new regression equation was developed accordingly. The new formula showed no statistically significant difference between the chronological and the estimated age for females, males, and total sample. The new formula, which hit the age with 72.80% accuracy, was more successful in predicting chronological age than other adjusted regression equations. The new regression model, created for the Turkish children by using both developing teeth and hand-wrist bones, was considerably successful in estimating the chronological age.

Sex Determination by the Machine Learning Algorithms Through Using Morphometric Measurements of the Carpal, Metacarpal, and Phalangeal Bones / Determinación del Sexo Mediante Algoritmos de Aprendizaje Automático Mediante el Uso de Mediciones Morfométricas de los Huesos del Carpo, el Metacarpo y las Falanges

SUMMARY: In the study, it was aimed to predict sex from hand measurements using machine learning algorithms (MLA). Measurements were made on MR images of 60 men and 60 women. Determined parameters; hand length (HL), palm length (PL), hand width (HW), wrist width (EBG), metacarpal I length (MIL), metacarpal I width (MIW), metacarpal II length (MIIL), metacarpal II width (MIIW), metacarpal III length (MIIL), metacarpal III width (MIIIW), metacarpal IV length (MIVL), metacarpal IV width (MIVW), metacarpal V length (MVL), metacarpal V width (MVW), phalanx I length (PILL), measured as phalanx II length (PIIL), phalanx III length (PIIL), phalanx IV length (PIVL), phalanx V length (PVL). In addition, the hand index (HI) was calculated. Logistic Regression (LR), Random Forest (RF), Linear Discriminant Analysis (LDA), K-nearest neighbour (KNN) and Naive Bayes (NB) were used as MLAs. In the study, the KNN algorithm's Accuracy, SEN, F1 and Specificity ratios were determined as 88 %. In this study using MLA, it is understood that the highest accuracy belongs to the KNN algorithm. Except for the hand's MIIW, MIIIW, MIVW, MVW, HI variables, other variables were statistically significant in terms of sex difference.

En el estudio, el objetivo era predecir el sexo a partir de mediciones manuales utilizando algoritmos de aprendizaje automático (MLA). Las mediciones se realizaron en imágenes de RM de 60 hombres y 60 mujeres. Parámetros determinados; longitud de la mano (HL), longitud de la palma (PL), ancho de la mano (HW), ancho de la muñeca (EBG), longitud del metacarpiano I (MIL), ancho del metacarpiano I (MIW), longitud del metacarpiano II (MIIL), ancho del metacarpiano II (MIIW), longitud del metacarpiano III (MIIL), ancho del metacarpiano III (MIIIW), longitud del metacarpiano IV (MIVL), ancho del metacarpiano IV (MIVW), longitud del metacarpiano V (MVL), ancho del metacarpiano V (MVW), longitud de la falange I (PILL), medido como longitud de la falange II (PIIL), longitud de la falange III (PIIL), longitud de la falange IV (PIVL), longitud de la falange V (PVL). Además, se calculó el índice de la mano (HI). Regresión logística (LR), Random Forest (RF), Análisis discriminante lineal (LDA), K-vecino más cercano (KNN) y Naive Bayes (NB) se utilizaron como MLA. En el estudio, las proporciones de precisión, SEN, F1 y especificidad del algoritmo KNN se determinaron en un 88 %. En este estudio que utiliza MLA, se entiende que la mayor precisión pertenece al algoritmo KNN. Excepto por las variables MIIW, MIIIW, MIVW, MVW, HI de la mano, otras variables fueron estadísticamente significativas en términos de diferencia de sexo.

Immediate Proximal Row Carpectomy for Severe Perilunate Dislocation Injuries: A Minimum 5-Year Follow-Up.

Background: In patients with perilunate injuries (PLI) with multiple ligamentous and bony injuries involving the proximal carpal row, open reduction and internal fixation (ORIF) can be difficult and lead to poor functional outcomes. Proximal row carpectomy (PRC) is an alternative procedure that has been used for severely comminuted fractures. The aim of our study is to evaluate the long-term functional outcome (minimum 5 years) of patients that underwent an emergency PRC for PLI. Methods: We conducted a retrospective study of patients who underwent PRC at our centre between 2001 and 2016. Only patients with follow-up data of more than 5 years were included in the study. We evaluated range of motion, grip strength, Mayo Modified Wrist Score (MMWS) and Quick Disabilities of Arm, Shoulder and Hand (Quick-DASH). Radiographic analyses were performed to assess the presence of radiocarpal osteoarthritis and the space between the radius and capitate. Results: Thirteen patients were included, with an average follow-up of 78.07 months (6.5 years). The MMWS was 65 points (four excellent and good, four fair and five poor results) and the Quick-DASH score was 30 points. X-ray analysis reported only 15.3% of patients with radiocarpal arthrosis and an average radio-capitate joint space of 1.92 mm. Conclusions: The outcomes of PRC in the management of PLI are comparable to the results reported in literature for conventional ORIF. PRC is a simpler procedure that minimises the need for re-intervention. Level of Evidence: Level IV (Therapeutic).

Quantitative 3-D CT Demonstrates Distal Row Pronation and Translation and Radiolunate Arthritis in the SNAC Wrist.

BACKGROUND: In scaphoid nonunion advanced collapse (SNAC) wrist arthritis, we analyzed the 3-dimensional (3-D) deformity patterns of carpal alignment secondary to scaphoid nonunion and quantified subchondral arthritis by investigating alterations in bone density. METHODS: We constructed 3-D models of the carpal bones and radius from 51 patients with scaphoid nonunion (nonunion group) and 50 healthy controls (control group). We quantified the differences in 3-D geometric position of the distal carpal row relative to the distal radius in SNAC wrists versus controls. In addition, we assessed the bone density of anatomic regions of interest in the radiocarpal and capitolunate joints relative to the pisiform bone density to characterize degenerative changes in SNAC wrists. RESULTS: The distal carpal row pronated by a difference of 14° (7.2° versus -6.7°; p < 0.001), deviated ulnarly by a difference of 19° (7.7° versus -11.2°; p < 0.001), shifted dorsally by a difference of 17% of the dorsovolar width of the distal radius (21.0% versus 4.4%; p < 0.001), shifted radially by a difference of 8% of the radioulnar width of the distal radius (13.2% versus 5.3%; p < 0.001), and migrated proximally by a difference of 12% of the lunate height (96.3% versus 108.8%; p < 0.001) in the nonunion group compared with the control group. Additionally, it was found that bone density was greater at the capitolunate joint (capitate head: 140.4% versus 123.7%; p < 0.001; distal lunate: 159.9% versus 146.3%; p < 0.001), the radial styloid (157.0% versus 136.3%; p < 0.001), and the radiolunate joint (proximal lunate: 134.8% versus 122.7%; p < 0.001; lunate fossa: 158.6% versus 148.1%; p = 0.005) in the nonunion group compared with the control group. CONCLUSIONS: Scaphoid nonunion exhibited a unique deformity pattern and alteration in bone-density distributions. The distal carpal row not only shifted dorsally and migrated proximally but also pronated, deviated ulnarly, and shifted radially. Bone density was greater at the capitolunate joint, the radial styloid, and surprisingly, the radiolunate joint. Our findings give insight into the natural history and progression of arthritis of the SNAC wrist. Additionally, future studies may give insight into whether successful treatment of scaphoid nonunion arrests the progression of arthritis. LEVEL OF EVIDENCE: Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.

Wrist and Distal Radioulnar Joint Arthroplasty: Maximizing Results in Difficult Conditions.

Traditional management of wrist arthritis consists of proximal row carpectomy, partial carpal fusions, or, in the event of pancarpal arthritis, total wrist fusion. Although proximal row carpectomy and partial wrist fusions preserve some motion at the wrist while relieving pain symptoms, the quality of results obtained from these procedures is not predictable or optimal in many instances. Management of hip, knee, ankle, and shoulder joints has evolved from arthrodesis to arthroplasty. The wrist joint is following the same pattern of evolution with the advent of reliable designs.

Coexisting Kienböck's and Preiser's Disease of the Wrist: Experience with Proximal Row Carpectomy with Dorsal Capsular Interposition Technique.

BACKGROUND: Idiopathic avascular necrosis of the lunate is known as Kienböck's disease and that of the scaphoid is known as Preiser's disease. Because the prevalence of coexisting Kienböck's and Preiser's diseases is very low, standardized stages of disease and treatments are not established. CASE PRESENTATION: We report coexisting avascular necrosis of the scaphoid and lunate in a 68-year-old woman with no history of steroids or other risk factors. We treated her with proximal row carpectomy with capsular interposition technique. A distal-based dorsal capsular flap was prepared and repaired the palmar capsule. At the last follow-up, she had no pain and had gained improved range of wrist motion. There was no arthritic change at the newly formed radiocapitate joint. CONCLUSIONS: In the case of collapsed lunate and scaphoid with avascular necrosis, the proximal row carpectomy procedure has an advantage. Proximal row carpectomy with dorsal capsular interposition can be performed when the lunate or scaphoid cannot be saved. Arthritic changes of the capitate head and distal radius lunate facet can be covered with the dorsal capsule.

Artificial Lunate Arthroplasty for Kienböck Disease With Multiple Extensor Tendon Ruptures: A Case Report.

CASE: A 73-year-old woman presented with wrist pain and loss of extension in the middle and ring fingers. Radiography revealed a dorsally displaced lunate fragment, resulting in a diagnosis of Kienböck disease with extensor tendon rupture. Artificial lunate replacement and tendon transfer were performed as treatment. Two years postoperatively, the pain was relieved, and the extension lag was 0°. The wrist motion and carpal height had also improved. CONCLUSION: Lunate excision, partial wrist arthrodesis, or proximal row carpectomy are known treatments for Kienböck disease with extensor tendon rupture. Lunate arthroplasty is a novel, useful treatment option for this condition.

Comparison of radiography and CT for the evaluation of third carpal bone slab fractures in Thoroughbred racehorses.

Slab fractures of the third carpal bone (C3) are a common cause of lameness in Thoroughbred racehorses. Information on fracture morphology is commonly obtained from radiographs or CT. This retrospective, methods comparison aimed to explore the agreement between radiography and CT for imaging C3 slab fractures and discuss the contribution of the latter to clinical case management. Thoroughbred racehorses with a slab or incomplete slab fracture of C3 identified on radiographs that subsequently underwent CT examination were included. Fracture characteristics (location, plane, classification, displacement, comminution) and fracture length as a percentage of the proximodistal length of the bone, termed the proximodistal fracture percentage (PFP) were recorded independently from both modalities and then compared. Across all fractures (n = 82) radiographs and CT showed slight agreement on the presence of comminution (Cohen's Kappa (κ) 0.108, P 0.031) and moderate agreement on fracture displacement (K 0.683, P < 0.001). Computed tomography identified comminution in 49 (59.8%) and displacement in nine (11.0%) fractures that were not detected by radiographs. Half of the fractures were only seen on flexed dorsoproximal-dorsodistal oblique (DPr-DDiO) radiographs and therefore were of unknown length without additional CT imaging. Incomplete fractures that could be measured on radiographs (n = 12) had a median (IQR) PFP of 40% (30%-52%) on radiographs and 53% (38%-59%) on CT, a statistically significant difference (P = 0.026). Radiography and CT showed the poorest agreement when determining the presence of comminution. Additionally, radiography often underestimated the incidence of displacement, and fracture length, and resulted in more fractures being classified as incomplete when compared to CT.

Assessing carpal kinematics following scapholunate interosseous ligament injury ex vivo using four-dimensional dynamic computed tomography.

BACKGROUND: Scapholunate interosseous ligament injuries are prevalent and often challenging to diagnose radiographically. Four-dimensional CT allows visualization of carpal bones during motion. We present a cadaveric model of sequential ligamentous sectionings ("injuries") to quantify their effects on interosseous proximities at the radioscaphoid joint and scapholunate interval. We hypothesized that injury, wrist position, and their interaction affect carpal arthrokinematics. METHODS: Eight cadaveric wrists were moved through flexion-extension and radioulnar deviation after injuries. Dynamic CT images of each motion were acquired in each injury condition using a second-generation dual-source CT scanner. Carpal osteokinematics were used to calculate arthrokinematic interosseous proximity distributions during motion. Median interosseous proximities were normalized and categorized by wrist position. Linear mixed-effects models and marginal means tests were used to compare distributions of median interosseous proximities. FINDINGS: The effect of wrist position was significant for both flexion-extension and radioulnar deviation at the radioscaphoid joint; the effect of injury was significant for flexion-extension at the scapholunate interval; and the effect of their interaction was significant for radioulnar deviation at the scapholunate interval. Across wrist positions, radioscaphoid median interosseous proximities were less able to distinguish injury conditions versus scapholunate proximities. Median interosseous proximities at the scapholunate interval are majoritively able to detect differences between less (Geissler I-III) versus more (Geissler IV) severe injuries when the wrist is flexed, extended, and ulnarly-deviated. INTERPRETATION: Dynamic CT enhances our understanding of carpal arthrokinematics in a cadaveric model of SLIL injury. Scapholunate median interosseous proximities in flexion, extension, and ulnar deviation best demonstrate ligamentous integrity.

[Carpal Malalignment in Malunited Fractures of the Distal Radius]. / Konstellationen des karpalen Gefüges bei fehlverheilten extraartikulären distalen Radiusfrakturen.

PURPOSE: To evaluate and classify carpal alignment in malunited fractures of the distal radius. MATERIALS AND METHODS: On standardized lateral radiographs of the involved wrist of 72 patients with a symptomatic extra-articular malunion of the distal radius, 43 with a dorsal and 29 with a palmar angulation, radius tilt (RT), radiolunate (RL) and lunocapitate angle were measured. Malposition of the radius was defined as RT plus 11° in dorsal malunion and RT minus 11° in palmar malunion. A palmar tilt of the radius was marked with a minus sign. At the time of corrective osteotomy 9 dorsal malunions underwent for different reasons evaluation of the scapholunate ligament with 4 having a complete scapholunate ligament disruption. RESULTS: With respect to the RL-angle, carpal malalignment was categorized as follows: type P with a RL-angle less than -12°, type K with a RL-angle between -12 and 10°, type A with a RL-angle more than 10°, but less than the malposition of the radius, type D with a RL-angle greater than the malposition of the radius. All types of carpal malalignment were found in both, dorsally and palmarly tilted malunion. Type A carpal alignment was identified as the leading type in dorsal malunion (25 out of 43 patients), whilst in palmar malunion colinear subluxation of the carpus (type C) was the dominant type (12 out of 29 patients). To return the hand to a neutral position the rotation of the lunate was compensated by a contrarotation of the capitate in the dorsal malunion. In the palmar malunion a dorsal extension of the capitate returned the hand to a neutral position. In 4 of the 5 patients with type D carpal alignment, who had scapholunate ligament evaluation, a complete ligament tear was found. CONCLUSION: In this study four different types of carpal alignment in malunited extra-articular fractures of the distal radius were identified. Based on this data we suspect that type D carpal alignment in dorsal malunion may be associated with a scapholunate ligament tear. Therefore, we recommend wrist arthroscopy for this group of patients.

Lunotriquetral Coalition.

Lunotriquetral (LT) coalition is the most common carpal coalition. Four morphological types of LT coalition have been described. LT coalition is usually asymptomatic, but rarely a fibrocartilaginous type may cause ulnar wrist pain. We report a case of bilateral asymptomatic LT coalition that was seen incidentally on conventional radiography taken after a wrist injury. Conventional radiography is the first imaging technique to detect and classify this type of LT coalition. Magnetic resonance imaging is a useful tool to investigate possible associated pathology of the carpal joints, particularly if surgical treatment of a symptomatic patient is anticipated.