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Capitate-Hamate Fusion

Discussion

  • limited fusion of the capitate to the hamate has also been used successfully to prevent carpal collapse;
  • however, following this procedure, grip strength is slow to return;
  • some believe that this is a poor treatment option, since it does not cross both carpal rows, and consequently is ineffective in causing transfer load to the ulnar side of the wrist;

capitate shortening w/ captiate-hamate fusion

  • may increase scaphoid loading by 20%;
  • captitate is shortened about 3 mm;
  • proximal pole of hamate is removed to prevent hamate-lunate articulation;

Technique

  • fusion is accomplished through a dorsal approach, decorticating adjacent surface of the capitate and hamate and packing this w/ cancellous bone;
  • slotted corticocancellous graft is then compressed between capitate and hamate;
  • six weeks of short-arm immobilization follows