Assaf Kadar1, Mohamed Morsy2, Yoo-Joon Sur3, Alexis T Laungani4, Osman Akdag5, Steven L Moran6. 1. Division of Plastic Surgery, Mayo Clinic, Rochester, MN; Orthopedic Division, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. 2. Division of Plastic Surgery, Mayo Clinic, Rochester, MN; Department of Orthopedic Surgery, Assiut University Hospital, Assiut, Egypt. 3. Division of Plastic Surgery, Mayo Clinic, Rochester, MN; Department of Orthopedic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, Catholic University of Korea, Uijeongbu, Republic of Korea. 4. Division of Plastic Surgery, Mayo Clinic, Rochester, MN. 5. Division of Plastic Surgery, Mayo Clinic, Rochester, MN; Department of Plastic Reconstructive and Aesthetic Surgery, Selcuk University, Konya, Turkey. 6. Division of Plastic Surgery, Mayo Clinic, Rochester, MN. Electronic address: moran.steven@mayo.edu.
Abstract
PURPOSE: To study the intraosseous 3-dimensional microvasculature of the capitate bone using a novel high-resolution micro-computed tomography (μCT) imaging technology, and to examine the blood supply as it relates to the most common fracture types. METHODS: Ten cadaveric wrists were injected with a lead-based contrast agent. The capitates were harvested and imaged using a μCT scanner. The intraosseous vascularity was incorporated into a 3-dimensional image. We measured the vascular pattern as well as the vessels' cross-sectional area, number, and distribution. An average capitate fracture line was calculated using clinical data from 22 patients with capitate fractures. The fracture line was projected on the representative capitate to assess its relation with the nutrient vessels' entry points. RESULTS: The capitate is a well-vascularized carpal supplied by dorsal and volar vascular systems that anastomose in 30% of cases. There was no predominance of one vascular system over the other. Most vessels enter the capitate at the distal half and supply the proximal pole in a retrograde fashion. In addition, most specimens (70%) also had at least one vessel entering the proximal pole through the volar capitate ligaments and supplying the proximal pole directly. The average fracture line had an oblique orientation, and 90% of the specimens had a blood vessel entering proximal to that line. CONCLUSIONS: This μCT vascular study further verifies that the capitate receives most of its vasculature in a retrograde fashion, but the study also shows that most capitates have vessels supplying the proximal pole directly. These findings might explain why most capitate waist fractures do not progress to proximal pole avascular necrosis. CLINICAL RELEVANCE: This study characterizes the microvasculature of the capitate and might shed light on processes involved in bone healing and the etiology of capitate avascular necrosis.
PURPOSE: To study the intraosseous 3-dimensional microvasculature of the capitate bone using a novel high-resolution micro-computed tomography (μCT) imaging technology, and to examine the blood supply as it relates to the most common fracture types. METHODS: Ten cadaveric wrists were injected with a lead-based contrast agent. The capitates were harvested and imaged using a μCT scanner. The intraosseous vascularity was incorporated into a 3-dimensional image. We measured the vascular pattern as well as the vessels' cross-sectional area, number, and distribution. An average capitate fracture line was calculated using clinical data from 22 patients with capitate fractures. The fracture line was projected on the representative capitate to assess its relation with the nutrient vessels' entry points. RESULTS: The capitate is a well-vascularized carpal supplied by dorsal and volar vascular systems that anastomose in 30% of cases. There was no predominance of one vascular system over the other. Most vessels enter the capitate at the distal half and supply the proximal pole in a retrograde fashion. In addition, most specimens (70%) also had at least one vessel entering the proximal pole through the volar capitate ligaments and supplying the proximal pole directly. The average fracture line had an oblique orientation, and 90% of the specimens had a blood vessel entering proximal to that line. CONCLUSIONS: This μCT vascular study further verifies that the capitate receives most of its vasculature in a retrograde fashion, but the study also shows that most capitates have vessels supplying the proximal pole directly. These findings might explain why most capitate waist fractures do not progress to proximal pole avascular necrosis. CLINICAL RELEVANCE: This study characterizes the microvasculature of the capitate and might shed light on processes involved in bone healing and the etiology of capitate avascular necrosis.
Authors: Fred T Finney; Aaron McPheters; Natalie V Singer; Jaron C Scott; Karl J Jepsen; James R Holmes; Paul G Talusan Journal: Foot Ankle Int Date: 2018-12-19 Impact factor: 2.827
Authors: Natalie V Singer; Noah E Saunders; James R Holmes; David M Walton; Fred T Finney; Karl J Jepsen; Paul G Talusan Journal: Foot Ankle Int Date: 2021-02-09 Impact factor: 2.827