Vascularized Bone Grafting for the Treatment of Capitate Avascular Necrosis

Avascular necrosis (AVN) of the capitate bone is a rare condition and it can be related to major trauma or idiopathy. Different treatments are available including soft tissue interposition and intercarpal arthrodesis including lunocapitate, scaphocapitate, four corner, and carpometacarpal fusions. Other surgical options are resection of the proximal pole and revascularization procedures. The main purpose of this article is to present two cases of AVN of the capitate treated with a revascularization procedure using the 4th–5th extensor compartment artery (4th–5th ECA). Two female patients with capitate AVN are reported with an average age of 30.5 years. Both cases were classified as type-I according to Milliez classification. The major complaint in each case was wrist pain that increased during activity. In both cases there was no history of trauma, smoking, diabetes, or hematologic diseases. Both patients had a diminished range of motion, grip, and strength. The definitive diagnosis was made with magnetic resonance imaging. Both patients underwent treatment revascularization of the capitate using a vascularized bone graft based on the 4th–5th ECA. At average follow-up of 12 months, each patient had improved with regards to pain and had increased grip strength. The literature does not describe a specific algorithm treatment for capitate AVN. We recommend revascularization of the capitate using the 4th–5th ECA in type-I Milliez classification in young patients without signs of carpal collapse.

AB1130 LOCALIZATION OF MRI INFLAMMATORY LESIONS OF THE HAND IN SCLERODERMA AND RHEUMATOID ARTHRITIS - COMPARATIVE STUDY

Background:Inflammatory lesions of hand are frquent clinical feature in rheumatoid artritis (RA), with lower frequency in pts with systemic sclerosis (SSc), also. MR is useful method for detecting and quantification of inflammatory lesion of the hand (bone oedema, erosions, synovitis) in RA and SSc.Objectives:The aim of the study was to compare MR hand feature in SSc (experimental) and RA (control group) and to detect the localisation of the highest OMERACT RAMRISinflammatory score on the hand in pts with SSc and RAMethods:110 pts with SSc and 60 with RA were investigated (mean age 53y). All the pts underwenr clinical examination, X ray and MR on the dominant hand and wrist. Contrast enhanced low field MRI of the wrist and MCP2-5 joints was performend to all the pts. MRI inflammatory changes (bone oedema,erosions, synovitis)were assessed and scored by OMERACT RAMRIS scoring system.Results:Clinical examination confirmed synovitis in 17.1%, and 78% of patients with SSc using MR I (p <0.001). In the SSc group, erosions (by MR method) was confirmed in 52 (63.4%), by radiography in 22 pts (27.5%), which is a significantly lower percentage (p <0.001). In the control RA group, erosion was confirmed in 34 (97.1%) by MR method, and by radiography in 6 (17.1%), which is a statistically significant difference (p <0.001). Mean values of total MR score of synovitis (2.69 ± 2.29: 4.37 ± 1.31), oedema (6.58 ± 10.89: 20.57 ± 10.23) and erosion (6.84 ± 7, 43: 18.60 ± 5.01) on the wrist of the dominant hand were significantly higher in subjects with control RA than in those in the experimental SSc (p < 0.001). Mean values of total MR score of synovitis (3.15 ± 2.95: 5.26 ± 2.09), oedema (3.99 ± 9.82: 10, 51 ± 7.90) and erosion (4, 04 ± 4.76: 9.69 ± 4.27) on the MCP joints of the dominant hand were significantly higher in the control RA subjects (p <0.001).The highest OMERACR RAMRIS synovitis score was on distal radioulnar (DRU joint) of hand in SSc and also In RA pts. The highest erosion score was found on capitate bone in SSc, but in lunate bone in RA pts. The highest bone oedema score was also found on capitate bone in SSc, but in lunate bone in RA pts. According to the MCP joints, the highest synovitis score was found on the second finger in SSc and RA, highest erosion score also on the second finger in SSc, but on the third finger in RA; The highest bone oedema score was found on the third finger in SSc, and olso on the third and fifth finger in RA ptsConclusion:MR inflammatory lesions in SSc are less frequent compared to that in RA but still in significant percentage, confirming the need for early detection and aggressive treatment of both, RA and SSc patients with joint involvementReferences:[1]Avouac J, Walker UA, Hachulla E, Riemekasten G, Cuomo G, Carreira PE, et al. Joint and tendon involvement predict disease progression in systemic sclerosis: a EUSTAR prospective study. Annals of the rheumatic diseases. 2016;75(1):103–9.[2]Abdel-Magied RA, Lotfi A, AbdelGawad EA. Magnetic resonance imaging versus musculoskeletal ultrasonography in detecting inflammatory arthropathy in systemic sclerosis patients with hand arthralgia. Rheumatology international. 2013;33(8):1961–6.doi:10.1007/s00296-013-2665-8.Disclosure of Interests:None declared

CT Image Measurement and Analysis of the Influence of Different Motion Modes on the Geometrical Morphology of Carpal Bone

The purpose of this study is to explore the influence of different movement modes on the geometrical morphology of carpal bones. In this study, Computed Tomography (CT) imaging is used for measurement and analysis. The results show that the changes of wrist bone volume of athletes are not significant compared with that of non-athletes, and the changes of bone density of the wrist bone are more obvious under the motion stress stimulation. According to results of CT imaging measurement and calculation, the average CT values of triangular bone, trapezoid bone, capitate bone and pisiform bone in the left hand and hamate bone in the right hand of the athlete are greater than that of the non-athlete, and the difference is statistically significant. Therefore, CT imaging technology can help to reconstruct the three-dimensional image of the carpal bone and deeply understand the geometric shape of the carpal bone of athletes.

Osteonecrosis of the Upper Extremity: MRI-Based Zonal Patterns and Differential Diagnosis

Regarding the upper extremity, osteonecrosis can relate to the humeral head and to any carpal bone, most commonly the lunate (Kienböck's disease), scaphoid (Preiser's disease and nonunion), and capitate bone (osteonecrosis of the capitate head). In children and adolescents, osteochondrosis is an important differential diagnosis at the epiphyses. Appropriate imaging of osteonecrosis depends on knowledge about blood supply, biomechanical load, and bone repair mechanisms. Contrast-enhanced MRI (ceMRI) enables the differentiation of up to three mostly band-shaped zones: necrotic tissue (proximal), hypervascular repair tissue (intermediate), and viable bone (distal). To distinguish between necrotic and repair zones, intravenous gadolinium is recommended in MRI. Osteosclerosis and insufficiency fractures in early and intermediate stages as well as osteoarthritis in advanced stages are best depicted using high-resolution CT (HRCT). The combination of HRCT and ceMRI allows for exact classification of osteonecrosis regarding morphology and viability.

A case of avascular necrosis of capitate bone in an air compressor jack hammer worker

Introduction: Avascular necrosis (AVN) is very rare in capitate bone. It mostly occurs due to direct trauma to wrist. However, it could also occur as the result of disturbed blood supply due to repetitive micro-trauma in rare cases. Case Report: In this report, a 30-year-old man who was an air compressor jack hammer worker with chronic wrist pain was presented. Imaging revealed a low-signal intensity lesion on T1-weighted which supported AVN of capitate. Blood supply damage was due to continuous stress to palmar hand as the consequence of working with air compressor jack hammer which led to AVN of capitate. Conclusion: AVN of capitate could occur as the result of repetitive micro-trauma. It has a high correlation with the job of patients. Radiography does not help in the first stages. Magnetic resonance imaging (MRI) has high diagnostic sensitivity. In the primary stages in patients with occupation-induced AVN, it could be improved by changing the job and temporary immobilization.

Fracture of the Body's Hamate Bone: Open Reduction Internal Fixation by Double Approach—A Case Report

Hamate fractures are rare. Their treatment depends on the displacement and type of fracture. We present the case and surgical technique of a 33-year-old male patient, who is a manual worker, with a displaced fracture of the body of the hamate bone associated with dislocation of the fourth and fifth metacarpal (MC) bones. The patient was operated on with a double palmar and dorsal approach directly over the hamate and the body hook, respectively, which was performed to improve the control reduction and avoid damaging the neighboring vascular and nerve structures. The open reduction internal fixation (ORIF) was performed by inserting mini-screws in a dorsal to palmar direction. Later, the dislocations were reduced and fixed with Kirschner wires between the fourth and fifth MC bases, and between the fourth MC base and the capitate bone. The patient was discharged 2.5 months after the fracture. The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire outcome measure was 5 points at 6 months postsurgery.

Giant Cell Tumor of the Capitate Bone

This case report describes a 16-year-old female patient with a giant cell tumor in her right capitate bone. The tumor was removed by intralesional curettage. A high-speed burr was used to extend the margins of the curettage, and alcohol irrigation was used for adjuvant therapy. The cavity of the capitate was filled with allogenic bone graft. There was no recurrence after 2 years of follow-up, and the right wrist radiographs demonstrated healing of the lesion.