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Thursday, January 2, 2020
Anatomy Question Re an Accessory Ulnar Wrist Ossicle
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No Hip Injury. Instead, subacute partial tear of the Sartorius at its ASIS origin (note reactive BME). At the cranial margin of the FOV we c... -
F 62, left hip pain. Suspected impingement. There's a subchondral / subcortical bone lesion at the anterior aspect of the left femoral h...
I received several comments, including the definition of the Os Triangulare and suggestion that this might be a Lunula. One suggested that it could still be an old ununited ulnar styloid avulsion even though the styloid looks smooth. But none really addressed the questions I asked.
ReplyDeleteI found this reference, an ECR poster from Puerto Rico (OCADer Jorge Vidal is co-author) which clarifies the difference between the Os Triangulare and Lunulahttps://posterng.netkey.at/esr/viewing/index.php?module=viewing_poster&task=viewsection&pi=142067&ti=509551&si=1720&searchkey=
They do not mention the "Hypotriquetrum" (which is mentioned only, so far as I see in Wikipedia...and maybe isn't a thing?). Based on the location, it seems this is more likely a Lunula than Os Triangulare...and that is embedded within the meniscal homologue of the TFCC.
I still think this is oddly distal to the styloid and I wonder if this might imply avulsion of the meniscal homologue and possibly more extensive TFCC injury.
Another comment from someone who believes that ALL of these so-called accessory ossicles about the wrist are old post-traumatic ossification rather than developmental variants.....citing that this is similar to inframalleolar/subfibular ossicles at the ankle. Does anyone believe that?
ReplyDeleteI'm not sure I can say that ALL these accessory ossicles in the wrist are actually post-traumatic ossifications. But I believe this one is. I agree it's not an unlar styloid avulsion.
ReplyDeleteI don't see any soft tissue irregularity medial/ulnar to this where the fat strip is. So I don't believe it has been acutely yanked off/out of the homologue or UCL or ECU subsheath. I bet it's totally incidental to the current injury. If the patient is tender there then an MRI would help of course but if I were dictating I would just say it's most likely old H.O. and less likely an accessory ossicle. Even if there is damage to those lesser components of the TFCC, the patient is going to be casted for weeks so it will just scar down and probably be okay. Thin filamentous collagen does that right?
Kirk