Vascularized Bone Grafting for the Treatment of Capitate Avascular Necrosis

Abstract

Avascular necrosis (AVN) of the capitate bone is a rare condition and it can be related to major trauma or idiopathy. Different treatments are available including soft tissue interposition and intercarpal arthrodesis including lunocapitate, scaphocapitate, four corner, and carpometacarpal fusions. Other surgical options are resection of the proximal pole and revascularization procedures. The main purpose of this article is to present two cases of AVN of the capitate treated with a revascularization procedure using the 4th–5th extensor compartment artery (4th–5th ECA). Two female patients with capitate AVN are reported with an average age of 30.5 years. Both cases were classified as type-I according to Milliez classification. The major complaint in each case was wrist pain that increased during activity. In both cases there was no history of trauma, smoking, diabetes, or hematologic diseases. Both patients had a diminished range of motion, grip, and strength. The definitive diagnosis was made with magnetic resonance imaging. Both patients underwent treatment revascularization of the capitate using a vascularized bone graft based on the 4th–5th ECA. At average follow-up of 12 months, each patient had improved with regards to pain and had increased grip strength. The literature does not describe a specific algorithm treatment for capitate AVN. We recommend revascularization of the capitate using the 4th–5th ECA in type-I Milliez classification in young patients without signs of carpal collapse.

Keywords

avascular necrosis - capitate - bone graft - carpal height - vascularized

Ethical Approval

All procedures were in accordance with the ethical standards of the responsible committee on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008. Written consent was obtained from the patients for their anonymized information to be published in this article.

Publication History

Received: 01 January 2021

Accepted: 09 February 2021

Article published online:
24 March 2021

• References

• 1 Hattori Y, Doi K, Sakamoto S, Yukata K, Shafi M, Akhundov K. Vascularized pedicled bone graft for avascular necrosis of the capitate: case report. J Hand Surg Am 2009; 34 (07) 1303-1307
• 2 Peters SJ, Degreef I, De Smet L. Avascular necrosis of the capitate: report of six cases and review of the literature. J Hand Surg Eur Vol 2015; 40 (05) 520-525
• 3 Tashjian RZ, Patel A, Akelman E, Weiss APPC. Avascular necrosis of the wrist and hand excluding the scaphoid and lunate. J Am Soc Surg Hand 2004; 4 (02) 109-116
• 4 Murakami H, Nishida J, Ehara S, Furumachi K, Shimamura T. Revascularization of avascular necrosis of the capitate bone. AJR Am J Roentgenol 2002; 179 (03) 664-666
• 5 Imai S, Uenaka K, Matsusue Y. Idiopathic necrosis of the capitate treated by vascularized bone graft based on the 2, 3 intercompartmental supraretinacular artery. J Hand Surg Eur Vol 2014; 39 (03) 322-323
• 6 Ferrand M, Bellemere P. Pyrocarbon interposition after capitate head resection. J Wrist Surg 2013; 2 (04) 351-354
• 7 Whiting J, Rotman MB. Scaphocapitolunate arthrodesis for idiopathic avascular necrosis of the capitate: a case report. J Hand Surg Am 2002; 27 (04) 692-696
• 8 Athlani L, Granero J, Dap F, Dautel G. Avascular necrosis of the capitate: case series of five patients and review of literature. J Hand Surg Eur Vol 2019; 44 (07) 702-707
• 9 Nattrass GR, King GJW, McMurtry RY, Brant RF. An alternative method for determination of the carpal height ratio. J Bone Joint Surg Am 1994; 76 (01) 88-94
• 10 Milliez PY, Kinh Kha H, Allieu Y, Thomine JM. Idiopathic aseptic osteonecrosis of the capitate bone. Literature review apropos of 3 new cases [in French]. Int Orthop 1991; 15 (02) 85-94
• 11 Butterworth JA, Moran SL. The management of avascular necrosis in the carpus: Preiser's disease and avascular necrosis of the capitate. In: Slutsky DJ. ed. Principles and Practice of Wrist Surgery. Philadelphia, PA: Saunders; 2009: 579-588
• 12 Niesten JA, Verhaar JAN. Idiopathic avascular necrosis of the capitate--a case report and a review of the literature. Hand Surg 2002; 7 (01) 159-161
• 13 Vander Grend R, Dell PC, Glowczewskie F, Leslie B, Ruby LK. Intraosseous blood supply of the capitate and its correlation with aseptic necrosis. J Hand Surg Am 1984; 9 (05) 677-683
• 14 Kadar A, Morsy M, Sur YJ, Laungani AT, Akdag O, Moran SL. The vascular anatomy of the capitate: new discoveries using micro-computed tomography imaging. J Hand Surg Am 2017; 42 (02) 78-86
• 15 Ye BJ, Kim JI, Lee HJ, Jung KY. A case of avascular necrosis of the capitate bone in a pallet car driver. J Occup Health 2009; 51 (05) 451-453
• 16 Usami S, Kawahara S, Inami K. Vascularized second metacarpal bone graft for the treatment of idiopathic osteonecrosis of the capitate. Hand (N Y) 2019; 15 (01) NP22-NP25
• 17 Shimizu T, Omokawa S, del Piñal F, Shigematsu K, Moritomo H, Tanaka Y. Arthroscopic partial capitate resection for type ia avascular necrosis: a short-term outcome analysis. J Hand Surg Am 2015; 40 (12) 2393-2400
• 18 Higgins JP, Bürger HK. Osteochondral flaps from the distal femur: expanding applications, harvest sites, and indications. J Reconstr Microsurg 2014; 30 (07) 483-490
• 19 Kazmers NH, Rozell JC, Rumball KM, Kozin SH, Zlotolow DA, Levin LS. Medial femoral condyle microvascular bone transfer as a treatment for capitate avascular necrosis: surgical technique and case report. J Hand Surg Am 2017; 42 (10) 841.e1-841.e6
• 20 Jagodzinski NA, Taylor CF, Al-Shawi AK. Pyrocarbon interposition arthroplasty for proximal capitate avascular necrosis. Hand (N Y) 2015; 10 (02) 239-242