Vascularized Second Metacarpal Bone Graft for the Treatment of Idiopathic Osteonecrosis of the Capitate

Abstract

Background: Idiopathic osteonecrosis of the capitate is rare condition with few reports of treatment using vascularized bone graft. Methods: A case of a 45-year-old woman with idiopathic necrosis of the capitate who underwent surgical treatment with a vascularized bone graft from the base of the second metacarpal bone is reported. Results: At 14 months postoperatively, the range of motion of her wrist was maintained, and localized wrist pain was relieved. Conclusions: This bone graft, which has a reliable pedicle with few anomalies, offers sufficient cancellous bone for the capitate, and can be harvested in the same operative field, is desirable for the treatment of osteonecrosis of the capitate.

Atraumatic Index Finger Flexor Tendon Rupture as a Presenting Sign of Capitate Osteonecrosis

“…Various treatment modalities have been reported for ON of the capitate, ranging from conservative treatment to arthrodesis 3,7 and vascularized bone graft 9,10 . Partial excision can also lead to favorable outcomes if the fragment is amenable and the rest of the bone has a good vascular supply 11 .…”

“…The etiology of ON of the capitate is varied and may result from repetitive microtrauma, acute trauma, systemic conditions, such as gout or chronic steroid use 1,[5][6][7] . Some cases are idiopathic 8,9 , whereas others have a remote history of trauma 10 . Presenting symptoms typically include a chronic history of wrist or hand pain but also include unique presentations, such as trigger wrist 11 .…”

Vascularized Bone Grafting for the Treatment of Capitate Avascular Necrosis

“…Other vascularized pedicled bone grafts described in the literature to treat capitate AVN include the 2–3 intercompartmental supraretinacular artery 5 and a pedicled vascularized bone graft from the second metacarpal. 16 At the end, this procedure does not burn any bridges and still allows for salvage procedures in the future.…”