CASE 2379 Published on 02.05.2005

Teaching Case

Section

Musculoskeletal system

Case Type

Clinical Cases

Authors

Parlorio E

Patient

47 years, male

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Clinical History

A 47-year-old male complained of pain in both wrists and he had no history of trauma.

Differential Diagnosis List

Unilateral bipartite carpal scaphoid.

Imaging Findings

A 47-year-old male complained of pain in both wrists and he had no history of trauma. Conventional radiography revealed a bipartite scaphoid as an incidental finding (Fig. 1).

Discussion

Normal skeletal variants are common in clinical practice, and sometimes lead to misinterpretation as their appearance may resemble a fracture. We illustrate a bipartite carpal scaphoid. Whether this condition is congenital has long been debated. Some authors support a traumatic origin (1), but others believe that bipartite scaphoid is a rare congenital anomaly (2, 3). The Holt–Oram syndrome includes anomalies of the scaphoid bone such as hypoplasia and bipartite ossification. The absence of a periscaphoid degenerative change has been suggested as a criterion for the diagnosis of congenital origin (4). The scaphoid bone may also be tripartite. In our case, the congenital origin was supported by the absence of trauma or surgery of the wrist.

References

[1] Louis DS, Calhoun TP, Garn SM, Carroll RE, Burdi AR. Congenital bipartite scaphoid--fact or fiction? J Bone Joint Surg Am 1976 Dec;58(8):1108-12. (PMID: 137245)

[2] Dubrana F, Le Nen D, Hu W, Poureyron Y, Pazart F, Lefevre C. Bilateral bipartite carpal scaphoid bone: a congenital disease or unrecognized pseudarthrosis? Discussion a propos of a clinical case.Rev Chir Orthop Reparatrice Appar Mot 1999 Sep;85(5):503-6. (PMID: 10507113)

[3] Doman AN, Marcus NW. Congenital bipartite scaphoid.
J Hand Surg [Am] 1990 Nov;15(6):869-73. (PMID: 2269775)

[4] Richards RR, Ledbetter WS, Transfeldt EE. Radiocarpal osteoarthritis associated with bilateral bipartite carpal scaphoid bones: a case report. Can J Surg 1987 Jul;30(4):289-91. (PMID: 3607646)

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