Lateral Femoral Trochlea Flap Reconstruction of the Proximal Capitate: An Assessment of Congruity and Description of Technique


      We examined morphologic similarities of the medial lateral femoral trochlea (MFT) and lateral femoral trochlea (LFT) osteochondral flaps for reconstruction of the proximal capitate.


      Magnetic resonance imaging scans of the wrists and ipsilateral knees of 10 young healthy volunteers were obtained. Three morphologic parameters were investigated, comparing the MFT and LFT harvest sites to the capitate proximal pole. The correspondingly relevant surgical planes were compared. The coronal plane radius of curvature (ROC) of the capitate was compared with the sagittal planes of the MFT and LFT. The sagittal plane ROC of the capitate was compared to the axial planes of the MFT and LFT. The angular relationship between the dorsal cortical surface of the capitate and the proximal pole cartilage (proximal dorsal capitate pitch) was compared to the corresponding angles between the cortical bone and convex cartilage on the LFT and MFT.


      The average ratios of ROC for the coronal planes of the capitate to the MFT (0.61) and LFT (0.58) were similar. The average ratios of ROC for the sagittal planes of the capitate to the MFT (0.57) and LFT (0.86) were also similar. The proximal dorsal capitate pitch demonstrated greater similarity to the corresponding shape of the LFT (angular ratio, 1.01) than to that of the MFT (angular ratio, 0.74).


      The LFT and MFT demonstrate similar congruity to the proximal capitate in the sagittal and coronal planes of the wrist. The LFT dorsal pitch closely approximates the relationship of the proximal capitate pole to its dorsal cortical surface.

      Clinical relevance

      In capitate fracture, fracture nonunion, or avascular necrosis, both the MFT and LFT demonstrate similarity to the proximal convex capitate morphology. The relationship between the cortical and chondral surfaces of the LFT is morphologically very similar to that of the proximal capitate.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Hand Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Suh N.
        • Ek E.T.
        • Wolfe S.W.
        Carpal fractures.
        J Hand Surg Am. 2014; 39 (quiz 791): 785-791
        • Sabat D.
        • Arora S.
        • Dhal A.
        Isolated capitate fracture with dorsal dislocation of proximal pole: a case report.
        Hand (N Y). 2011; 6: 333-336
        • Gümüştaş S.A.
        • Tosun H.B.
        • Ağır I.
        • Uludağ A.
        Nonunion of capitate due to late diagnosis in a teenager.
        Am J Case Rep. 2014; 15: 139-142
        • Freeland A.E.
        • Pesut T.A.
        Oblique capitate fracture of the wrist.
        Orthopedics. 2004; 27: 287-290
        • Yoshihara M.
        • Sakai A.
        • Toba N.
        • Okimoto N.
        • Shimokobe T.
        • Nakamura T.
        Nonunion of the isolated capitate waist fracture.
        J Orthop Sci. 2002; 7: 578-580
        • Jethanandani R.G.
        • Rancy S.K.
        • Corpus K.T.
        • Yao J.
        • Wolfe S.W.
        Management of isolated capitate nonunion: a case series and literature review.
        J Wrist Surg. 2018; 7: 419-423
        • Kadar A.
        • Morsy M.
        • Sur Y.J.
        • Laungani A.T.
        • Akdag O.
        • Moran S.L.
        The vascular anatomy of the capitate: new discoveries using micro-computed tomography imaging.
        J Hand Surg Am. 2017; 42: 78-86
        • Higgins J.P.
        • Bürger H.K.
        The use of osteochondral flaps in the treatment of carpal disorders.
        J Hand Surg Eur Vol. 2018; 43: 48-56
        • Kälicke T.
        • Bürger H.
        • Müller E.J.
        A new vascularized cartilague-bone-graft for scaphoid nonunion with avascular necrosis of the proximal pole. Description of a new type of surgical procedure.
        Unfallchirurg. 2008; 111: 201-205
        • Bürger H.K.
        • Windhofer C.
        • Gaggl A.J.
        • Higgins J.P.
        Vascularized medial femoral trochlea osteocartilaginous flap reconstruction of proximal pole scaphoid nonunions.
        J Hand Surg Am. 2013; 38: 690-700
        • Bürger H.K.
        • Windhofer C.
        • Gaggl A.J.
        • Higgins J.P.
        Vascularized medial femoral trochlea osteochondral flap reconstruction of advanced Kienbock disease.
        J Hand Surg Am. 2014; 39: 1313-1322
        • Higgins J.P.
        • Bürger H.K.
        Osteochondral flaps from the distal femur: expanding applications, harvest sites, and indications.
        J Reconstr Microsurg. 2014; 30: 483-490
        • Hugon S.
        • Koninckx A.
        • Barbier O.
        Vascularized osteochondral graft from the medial femoral trochlea: anatomical study and clinical perspectives.
        Surg Radiol Anat. 2010; 32: 817-825
        • Wong V.W.
        • Higgins J.P.
        Distally based iliotibial band flap: anatomic study with surgical considerations.
        J Reconstr Microsurg. 2016; 32: 551-555
        • Wong V.W.
        • Bürger H.K.
        • Iorio M.L.
        • Higgins J.P.
        Lateral femoral condyle flap: an alternative source of vascularized bone from the distal femur.
        J Hand Surg Am. 2015; 40: 1972-1980
        • Morsy M.
        • Sur Y.J.
        • Akdag O.
        • et al.
        Anatomic and high-resolution computed tomographic angiography study of the lateral femoral condyle flap: implications for surgical dissection.
        J Plast Reconstr Aesthet Surg. 2018; 71: 33-43
        • Reddy A.S.
        • Frederick R.W.
        Evaluation of the intraosseous and extraosseous blood supply to the distal femoral condyles.
        Am J Sports Med. 1998; 26: 415-419
        • Rand J.A.
        • Linscheid R.L.
        • Dobyns J.H.
        Capitate fractures: a long-term follow-up.
        Clin Orthop Relat Res. 1982; 165: 209-216
        • Dunn J.C.
        • Polmear M.M.
        • Scanaliato J.P.
        • Orr J.D.
        • Nesti L.J.
        Capitolunate arthrodesis: a systematic review.
        J Hand Surg Am. 2020; 45: 365.e1-365.e10
        • Athlani L.
        • Granero J.
        • Dap F.
        • Dautel G.
        Avascular necrosis of the capitate: case series of five patients and review of literature.
        J Hand Surg Eur Vol. 2019; 44: 702-707
        • Parvizi D.
        • Vasilyeva A.
        • Wurzer P.
        • et al.
        Anatomy of the vascularized lateral femoral condyle flap.
        Plast Reconstr Surg. 2016; 137: 1024e-1032e