DOS 2018

84 · DOS Abstracts Os epilunatum as a rare cause of wrist pain. A case report Charlotte Hartig-Andreasen, Bo Munk Orthopedic Surgery, Aarhus University Hospital Background: Atraumatic wrist pain may be due to accessory carpal ossicles. The incidence of ossicles in the wrist is 1.6%. An epilunatum is an extreme rare ossicle located dorsal to the scaphoid, lunate and the capitate. Only one clinical case with an epilunatum is described in the literature. Purpose / Aim of Study: To describe a atypical cause of chronic wrist pain, and result of surgery. Materials and Methods: Case presentation: A 28-year-old male IT- worker with right-handed wrist pain through 6 years. At that time he was employed as a contractor, but due to increasing wrist pain and decreased extension of the wrist he changed to a job with less manual work. No history of trauma. Clinical exam of the hand showed active extension close to 0° and flexion to 30°-40°. No symptoms from the opposite hand. Findings / Results: Lateral wrist radiographs showed an ossicle dorsal to the lunate. Magnetic resonance imaging showed an os epilunatum with a fibrous connection to the lunate. The scapholunate (SL) and lunotriquetral (LT) liga- ment was intact. At surgery a dorsal approach was used. The epilunatum clearly collided with the dorsal rim of radius preventing extension of the wrist. The epilunatum was enucleated without damaging the SL and the LT ligament. Postoperatively extension increased to 60 degrees, and he achieved full flexion. For maintaining the achieved range of motion the patient was referred to hand therapy. At 3 months follow-up, the patient was pain free. Active/passive ex- tension was 50°/60° and flexion 45°/75°. Conclusions: Discussion: Chronic wrist pain may be caused be accessory os- sicles. The epilunate is close related to the SL ligament, and surgery is not with- out risk of compromising the stability of the hand. In our case enucleation of the epilunatum resolves the pain and improves range of motion without causing instability of the hand. 26 B.