Congenital Symptomatic Scaphoid-Trapezium Coalition in a Pediatric Patient With VACTERL Association

Early human evidence such as case series or small samples is exploring possible benefits.

• Level A · Stronger Clinical Evidence
• Level B · Emerging clinical evidence with positive signals
• Level C · Early human research exploring benefits
• Level D · Scientific groundwork from lab and animal studies
• Emerging · Emerging topic under active research

Abstract (original English)

Carpal coalition is the union between two or more carpals that should otherwise have uninterrupted mobility. Of those reported among pediatric populations, the vast majority are lunotriquetral (69.2%) or capitohamate (17.3%), while scaphotrapezial (ST) is among the most rare. Here, we report a case of a pediatric patient with symptomatic congenital ST coalition as part of the VACTERL association that resolved with surgical intervention. A 9-year-old right-hand-dominant girl with consistent right wrist and snuffbox pain following an incidental fall-on-outstretched hand was later revealed to be symptomatic of congenital ST coalition and unrecognized Blauth grade 1 thumb hypoplasia. Her medical history was notable for a ventricular-septal defect and tracheoesophageal fistula, suggesting a possible VACTERL association. Initial radiographs revealed no acute fractures, but demonstrated developmentally abnormal carpus. The patient experienced continued pain in the radial aspect of her right wrist and first carpometacarpal joint for 5 months despite immobilization and conservative treatment. Physical examination revealed carpometacarpal joint tenderness, unrecognized thumb hypoplasia with underdeveloped thenar musculature, weakened thumb grip, and reduced oppositional movement. Magnetic resonance imaging confirmed hypoplastic thumb and ST coalition, with genetic testing consistent VACT

Evidence level

Early human evidence such as case series or small samples is exploring possible benefits.

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