Lateral Femoral Trochlea Flap Reconstruction of the Proximal Capitate: An Assessment of Congruity and Description of Technique

James P Higgins; Gianna M Guarino; Christopher M Belyea; Scott M Tintle

doi:10.1016/j.jhsa.2022.04.015

Lateral Femoral Trochlea Flap Reconstruction of the Proximal Capitate: An Assessment of Congruity and Description of Technique

J Hand Surg Am. 2023 Feb;48(2):149-157. doi: 10.1016/j.jhsa.2022.04.015. Epub 2022 Jul 21.

Authors

James P Higgins¹, Gianna M Guarino², Christopher M Belyea³, Scott M Tintle⁴

Affiliations

¹ The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD. Electronic address: editor@curtishand.com.
² The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD.
³ The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD; Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD.
⁴ Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD.

PMID: 35870956
DOI: 10.1016/j.jhsa.2022.04.015

Abstract

Purpose: We examined morphologic similarities of the medial lateral femoral trochlea (MFT) and lateral femoral trochlea (LFT) osteochondral flaps for reconstruction of the proximal capitate.

Methods: Magnetic resonance imaging scans of the wrists and ipsilateral knees of 10 young healthy volunteers were obtained. Three morphologic parameters were investigated, comparing the MFT and LFT harvest sites to the capitate proximal pole. The correspondingly relevant surgical planes were compared. The coronal plane radius of curvature (ROC) of the capitate was compared with the sagittal planes of the MFT and LFT. The sagittal plane ROC of the capitate was compared to the axial planes of the MFT and LFT. The angular relationship between the dorsal cortical surface of the capitate and the proximal pole cartilage (proximal dorsal capitate pitch) was compared to the corresponding angles between the cortical bone and convex cartilage on the LFT and MFT.

Results: The average ratios of ROC for the coronal planes of the capitate to the MFT (0.61) and LFT (0.58) were similar. The average ratios of ROC for the sagittal planes of the capitate to the MFT (0.57) and LFT (0.86) were also similar. The proximal dorsal capitate pitch demonstrated greater similarity to the corresponding shape of the LFT (angular ratio, 1.01) than to that of the MFT (angular ratio, 0.74).

Conclusions: The LFT and MFT demonstrate similar congruity to the proximal capitate in the sagittal and coronal planes of the wrist. The LFT dorsal pitch closely approximates the relationship of the proximal capitate pole to its dorsal cortical surface.

Clinical relevance: In capitate fracture, fracture nonunion, or avascular necrosis, both the MFT and LFT demonstrate similarity to the proximal convex capitate morphology. The relationship between the cortical and chondral surfaces of the LFT is morphologically very similar to that of the proximal capitate.

Keywords: Capitate avascular necrosis; capitate nonunion; lateral femoral condyle flap; lateral femoral trochlea flap; vascularized bone.

Publication types

Editorial

MeSH terms

Capitate Bone* / diagnostic imaging
Capitate Bone* / surgery
Cartilage
Humans
Osteonecrosis* / surgery
Surgical Flaps / blood supply
Wrist