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Avascular necrosis of the capitate.
MedLine Citation:
PMID:  21053872     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
Although a large portion of the capitate is supplied by a single nutrient vessel, avascular necrosis of the capitatum is a rare condition. Its etiology is not clear, but a number of factors are linked to its pathogenesis including: repetitive trauma, dorsal instability of the carpus, Gaucher disease, systemic lupus erythematosus, gout, and steroid use. A 24-year-old woman presented with right wrist pain of 12 months duration. She reported no major trauma and reported that her pain had begun during the third month of her pregnancy. She had a history of hyperemesis gravidarum treated with 2 to 4 mg/daily of prednisone during her pregnancy for 6 weeks. She had 70° extension and 45° flexion of her wrist. Radiographs showed a hypodense area at the capitate head and midcarpal joint arthritis. Magnetic resonance imaging demonstrated avascular necrosis of the capitate and midcarpal collapse at the lunocapitate joint. Lunocapitate fusion with a partial scaphoidectomy was performed. At final follow-up 28 months postoperatively, she had 60° of volar flexion, and 50° of dorsiflexion. She was pain free in the majority of her activities of daily living. A small dose of steroid use during pregnancy, even in a short period of time, is a potential risk for avascular necrosis of the capitate and patients with a gradual onset of wrist pain during pregnancy may need to be investigated further if symptoms are not resolved with basic nonoperative measures within a reasonable time frame.
Authors:
Serdar Toker; Kagan Ozer
Publication Detail:
Type:  Journal Article     Date:  2010-11-02
Journal Detail:
Title:  Orthopedics     Volume:  33     ISSN:  1938-2367     ISO Abbreviation:  Orthopedics     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-11-08     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7806107     Medline TA:  Orthopedics     Country:  United States    
Other Details:
Languages:  eng     Pagination:  850     Citation Subset:  IM    
Copyright Information:
Copyright 2010, SLACK Incorporated.
Affiliation:
Denver Health Orthopedic Research Center, Denver, Colorado, USA. serdar.toker@dhha.org
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