Capitate Morphology: A New Radiographic Association with Preiser's Disease

Cheng-En Hsu; Parunyu Vilai; Rou Wan; Chunfeng Zhao; Steven L. Moran

doi:10.1055/a-2745-8586

Journal of Wrist Surgery, Inhaltsverzeichnis

J Wrist Surg
DOI: 10.1055/a-2745-8586

Scientific Article

Capitate Morphology: A New Radiographic Association with Preiser's Disease

Autor*innen

Cheng-En Hsu

¹Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, United States

²Department of Plastic Surgery, Mayo Clinic, Rochester, Minnesota, United States

³Department of Orthopaedics, Taichung Veterans General Hospital, Taichung, Taiwan

⁴Sports Recreation and Health Management Continuing Studies – Bachelor's Degree Completion Program, Tunghai University, Taichung, Taiwan
Parunyu Vilai

¹Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, United States

⁵Department of Orthopedic Surgery, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand
Rou Wan

¹Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, United States
Chunfeng Zhao

¹Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, United States
Steven L. Moran

²Department of Plastic Surgery, Mayo Clinic, Rochester, Minnesota, United States

Abstract

Purpose

Preiser's disease (PD), or idiopathic avascular necrosis of the scaphoid, is a debilitating condition leading to wrist pain, dysfunction, and pan-carpal arthritis. While impaired scaphoid vascularity is central to its pathogenesis, identifying individuals at risk is challenging due to the morphological distortion of the scaphoid as the disease progresses. This study aims to investigate the association between a novel capitate morphology classification, scaphoid morphology, and their impact on PD prevalence and characteristics. We also re-evaluate negative ulnar variance (NUV) as a potential risk factor for PD.

Materials and Methods

This retrospective case–control study included 34 PD patients and 340 age-matched controls. Capitate morphology was classified into Type I/II on anteroposterior (AP) radiographs based on capitotrapezoid–scaphocapitate (CT–SC) joint line angle and ratio. Scaphoid morphology was assessed via the waist index on contralateral healthy wrists. Radiographic measurements of ulnar variance and PD staging were also performed. Statistical analyses compared morphological prevalence and risk factors between groups.

Results

Type II capitate was significantly more prevalent in the PD group (35.3%) than in controls (17.1%, p = 0.018). Similarly, NUV was significantly higher in PD patients (29%) compared with controls (6.8%, p < 0.001). We found a strong correlation between Type II capitate and slender (Type II) scaphoid morphology in healthy wrists. No significant differences in age, gender, or affected side were observed. Interobserver and intraobserver agreements for capitate classification were substantial (kappa ≥0.882).

Conclusion

Our study introduces a reliable radiographic method for classifying capitate morphology, which strongly correlates with intrinsic scaphoid shape and potential vascular vulnerability. Both Type II capitate morphology and NUV are significant predisposing factors for PD. These findings offer valuable insights for identifying at-risk individuals and improving understanding of PD's multifactorial etiology.

Level of Evidence

Diagnostic Level III.

Keywords

Preiser's disease - ulnar variance - capitate - vascular anatomy - type II scaphoid - scaphoid morphology - capitate morphology

Volltext

Referenzen

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