Management of capitate avascular necrosis in an adult with a free medial femoral condyle flap

Abstract

The treatment of the extremely uncommon avascular necrosis of the capitate with a medial femoral condyle corticocancellous free flap has been described previously by one group reporting on outcomes in a paediatric patient. However, no literature to-date has detailed results of this procedure in an adult. We illustrate the case of a 53-year-old man who sustained capitate avascular necrosis and tendon rupture of traumatic aetiology. He was managed by resection of the necrotic segment, followed by inset of the medial femoral condyle free flap with the novel applications of indocyanine green to ensure adequate perfusion and intramedullary cannulated screw fixation of the capitate. Tendon transfer was also performed in the same operative sitting. At 9 months postoperatively, the patient displayed full range of motion of the wrist without any pain, and the imaging demonstrated union. This microsurgical approach may be performed in adult patients with favourable postoperative outcomes.

Keywords: Avascular necrosis; Cannulated screw; Capitate; Free flap; Hand surgery; Medial femoral condyle.