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  11. Idiopathic Avascular Necrosis Of The Capitate Treated With A Medial Femoral Trochlea Vascularized Osteochondral Flap: A Case Report

Idiopathic Avascular Necrosis of the Capitate Treated with a Medial Femoral Trochlea Vascularized Osteochondral Flap: A Case Report

Steven D Kozusko1, Jeffrey D Hassebrock, A Bobby Chhabra

  • 1Department of Orthopedic Surgery, University of Virginia, Charlottesville, Virginia.

JBJS Case Connector
|April 26, 2024

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View abstract on PubMed

Summary
This summary is machine-generated.

Avascular necrosis (AVN) of the capitate is a challenging wrist condition. A medial femoral trochlea vascularized flap successfully treated a laborer

Area of Science:

  • Orthopedic Surgery
  • Microsurgery
  • Musculoskeletal Research

Background:

  • Avascular necrosis (AVN) of the capitate is a rare but debilitating condition.
  • Midcarpal wrist pain in young, active adults warrants consideration of capitate AVN.
  • Accurate diagnosis requires advanced imaging and diagnostic arthroscopy.

Observation:

  • A 30-year-old laborer presented with right proximal capitate AVN.
  • Examination revealed limited grip strength and wrist motion.
  • Advanced imaging and arthroscopy confirmed the diagnosis.

Findings:

  • Surgical reconstruction using a medial femoral trochlea (MFT) vascularized flap with cartilaginous resurfacing was performed.
  • The MFT flap was harvested from the medial femur based on the descending genicular artery.

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  • A two-surgeon approach facilitated simultaneous dissection and flap transfer.

    • Implications:

    • The MFT vascularized bone transfer is a viable treatment for capitate AVN and nonunion.
    • This technique allows for cartilaginous resurfacing and restoration of wrist function.
    • The patient returned to full-time labor without restrictions after 10-month follow-up.