Mid-Carpal Joint Sparing Procedure for Idiopathic Avascular Necrosis of Capitate

Abstract

Background Avascular necrosis of the capitate (AVNC) is an uncommon pathology of the wrist. Several procedures have been described for the treatment of AVNC. The type of treatment varies depending upon the stages. In early stages, revascularization procedures are performed. If secondary osteoarthritis develops, then the treatment options include intercarpal fusion, four corner fusion, prosthesis replacement of the capitate, tendon interposition, and wrist arthrodesis. No long-term study is available for choosing an appropriate method of the treatment for AVNC.

Case Description Herein, we report a case of AVNC that was managed by hemi-resection of the capitate with capito-hamate fusion and tendon interposition. One year after surgery, patient was asymptomatic and radiographs revealed fusion of capito-hamate joint and maintenance of the mid-carpal joint space. There was no evidence of carpal collapse.

Literature Review All the literature about mid-carpal joint sparing (MCJS) procedures has been reviewed in this report. This is a goal behind writing of this case report as there have been very few publications about these procedures.

Clinical Relevance This case illustrates the successful treatment of AVNC by MCJS procedure. The intercarpal fusion and the four corner fusion are one time procedures, and these can be used if the MCJS procedure fails or sometimes, as primary procedure, if the patient gives consent for the same. It appears prudent to save arthrodesis procedures for the future.

Keywords

avascular necrosis - capitates - mid-carpal joint - fusion

Publication History

Received: 04 July 2020

Accepted: 14 September 2020

Article published online:
23 October 2020

• References

• 1 Jonsson G. Aseptic bone necrosis of the OsCapitatum (Os Magnum). Acta Radiol 1942; 23 (06) 562-564
• 2 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
• 3 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
• 4 Milliez PY, Kha HK, Allieu Y, Thomine JM. Essential aseptic osteonecrosis of the large bone. Int Orthop 1991; 15 (02) 85-94
• 5 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
• 6 Kimmel RB, O'Brien ET. Surgical treatment of avascular necrosis of the proximal pole of the capitate: case report. J Hand Surg Am 1982; 7 (03) 284-286
• 7 Gadzaly D. Therapie der Capitatumnekrose durch alloplastischen Teilersatz. [Therapy of capitate bone necrosis by partial alloplastic replacement] Z Orthop Ihre Grenzgeb 1983; 121 (03) 328-330
• 8 Lapinsky AS, Mack GR. Avascular necrosis of the capitate: a case report. J Hand Surg Am 1992; 17 (06) 1090-1092
• 9 DeSantis DP. Postsurgical rehabilitative management of avascular necrosis in the capitate. J Manipulative Physiol Ther 2004; 27 (08) 519-524
• 10 Dereudre G, Kaba A, Pansard E, Mathevon H, Mares O. Ostéonécrose aseptique du grand os et traitement : à propos d'un cas et d'une revue de la littérature. Chir Main 2010; 29 (03) 203-206
• 11 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