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J Wrist Surg
DOI: 10.1055/a-2745-8586
Scientific Article

Capitate Morphology: A New Radiographic Association with Preiser's Disease

Authors

  • Cheng-En Hsu

    1   Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, United States
    2   Department of Plastic Surgery, Mayo Clinic, Rochester, Minnesota, United States
    3   Department of Orthopaedics, Taichung Veterans General Hospital, Taichung, Taiwan
    4   Sports Recreation and Health Management Continuing Studies – Bachelor's Degree Completion Program, Tunghai University, Taichung, Taiwan

  • Parunyu Vilai

    1   Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, United States
    5   Department of Orthopedic Surgery, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand

  • Rou Wan

    1   Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, United States

  • Chunfeng Zhao

    1   Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, United States

  • Steven L. Moran

    2   Department of Plastic Surgery, Mayo Clinic, Rochester, Minnesota, United States
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Abstract

Purpose

Preiser's disease (PD), or idiopathic avascular necrosis of the scaphoid, is a debilitating condition leading to wrist pain, dysfunction, and pan-carpal arthritis. While impaired scaphoid vascularity is central to its pathogenesis, identifying individuals at risk is challenging due to the morphological distortion of the scaphoid as the disease progresses. This study aims to investigate the association between a novel capitate morphology classification, scaphoid morphology, and their impact on PD prevalence and characteristics. We also re-evaluate negative ulnar variance (NUV) as a potential risk factor for PD.

Materials and Methods

This retrospective case–control study included 34 PD patients and 340 age-matched controls. Capitate morphology was classified into Type I/II on anteroposterior (AP) radiographs based on capitotrapezoid–scaphocapitate (CT–SC) joint line angle and ratio. Scaphoid morphology was assessed via the waist index on contralateral healthy wrists. Radiographic measurements of ulnar variance and PD staging were also performed. Statistical analyses compared morphological prevalence and risk factors between groups.

Results

Type II capitate was significantly more prevalent in the PD group (35.3%) than in controls (17.1%, p = 0.018). Similarly, NUV was significantly higher in PD patients (29%) compared with controls (6.8%, p < 0.001). We found a strong correlation between Type II capitate and slender (Type II) scaphoid morphology in healthy wrists. No significant differences in age, gender, or affected side were observed. Interobserver and intraobserver agreements for capitate classification were substantial (kappa ≥0.882).

Conclusion

Our study introduces a reliable radiographic method for classifying capitate morphology, which strongly correlates with intrinsic scaphoid shape and potential vascular vulnerability. Both Type II capitate morphology and NUV are significant predisposing factors for PD. These findings offer valuable insights for identifying at-risk individuals and improving understanding of PD's multifactorial etiology.

Level of Evidence

Diagnostic Level III.

Keywords

Preiser's disease - ulnar variance - capitate - vascular anatomy - type II scaphoid - scaphoid morphology - capitate morphology

Ethical Approval

Approval from our institutional review board was obtained for this retrospective study. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.




Publication History

Received: 23 July 2025

Accepted: 10 November 2025

Article published online:
04 December 2025

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