Three-Dimensional Computed Tomography-based Analysis of Joint Contact Area Changes After Capitate Shortening Osteotomy in Kienböck Disease: A Retrospective Case Series

Three-Dimensional Computed Tomography-based Analysis of Joint Contact Area Changes After Capitate Shortening Osteotomy in Kienböck Disease: A Retrospective Case Series | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Three-Dimensional Computed Tomography-based Analysis of Joint Contact Area Changes After Capitate Shortening Osteotomy in Kienböck Disease: A Retrospective Case Series Hideyuki Kobayashi, Daisuke Momma, Yuichiro Matsui, Junki Shiota, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8938160/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: To evaluate changes in wrist joint contact after capitate-shortening osteotomy for Kienböck disease using in-vivo three-dimensional (3D) computed tomography-based bone models. Methods: In a multicenter retrospective case series, six wrists of six patients undergoing isolated capitate-shortening osteotomy for Kienböck disease were analyzed. Pre- and postoperative CT datasets were reconstructed into patient-specific bone models. Contact areas between the radius and carpal bones and among intercarpal joints were quantified, and contact-centroid locations were computed to evaluate the spatial redistribution of load. The primary outcomes were radiolunate, radioscaphoid, and lunocapitate contact areas, and the secondary outcomes were centroid shifts indicating the direction of load transfer. Results: Six patients were classified as Lichtman stage II (3 wrists), IIIA (2 wrists), and IIIB (1 wrist); all showed significant improvements in VAS and MMWS during follow-up. Postoperatively, radiolunate and lunocapitate contact areas decreased, whereas the radioscaphoid contact area increased; these changes were statistically significant. The centroid analysis revealed a dorsoradial shift at the radioscaphoid region and a palmar shift at the lunocapitate region. Conclusions: Capitate-shortening osteotomy was associated with decreased radiolunate and lunocapitate contact areas and increased radioscaphoid contact area on three-dimensional CT-based models. These findings support the rationale for capitate shortening as a procedure that influences wrist joint contact patterns in Kienböck disease and provide objective imaging metrics that may aid postoperative evaluation and future comparative studies. Clinical trial number:Not applicable. Kienböck disease Capitate shortening osteotomy Wrist joint Contact area Three-dimensional computed tomography Biomechanics Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 BACKGROUND Kienböck disease is characterized by necrosis of the lunate bone. Various clinical studies have indicated a positive correlation between the incidence of Kienböck disease and ulnar variance, indicating that a relatively longer radius exerts excessive force on the lunate bone, leading to vascular necrosis [ 1 , 2 ]. However, not all cases of Kienböck disease exhibit negative ulnar variance, and its exact etiology remains unclear. Various surgical procedures have been reported depending on the stage of Kienböck disease. Capitate shortening osteotomy provides significant pain relief and revascularization of the lunate bone in patients with neutral or positive ulnar variance [ 3 , 4 ]. Capitate shortening osteotomy distributes the load on the lunate to the adjacent carpal bones; however, changes in the biological environment remain underexplored [ 5 , 6 ]. Changes in the wrist contact area have been reported in Kienböck disease, indicating that the mechanical load on the wrist can be understood by measuring the wrist contact pattern [ 7 – 9 ]. We hypothesized that capitate shortening osteotomy would change the contact area of the wrist joint. This study aimed to evaluate the contact area of the wrist in Kienböck disease before and after capitate shortening osteotomy and examine the mechanical changes resulting from surgery. METHODS Patients This study retrospectively analyzed patients who underwent capitate shortening osteotomy for Kienböck disease. A total of 7 patients underwent the procedure between 2011 and 2017. One case without postoperative computed tomography (CT) data was excluded, leaving 6 patients for analysis. No additional exclusion criteria were applied other than the availability of postoperative CT data. The cases were collected from two hospitals, and the surgeries were performed by multiple surgeons. Data of CT, plain radiography, and clinical assessments before and after surgery were collected. To evaluate pre- and post-operative pain and wrist range of motion, the Visual Analog Scale (VAS) and Modified Mayo Wrist Scoring System (MMWS) were employed. The carpal height ratio (CHR) and Stahl index were calculated using radiographs [ 10 , 11 ]. This study was reported in accordance with the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines. Surgical technique The surgical procedure has been previously described in detail [ 4 ]. Briefly, a longitudinal skin incision of approximately 3 cm was made over the dorsal aspect of the capitate. The extensor tendons were retracted, and the wrist joint capsule, along with the dorsal intercarpal ligament were incised longitudinally. The capitate was exposed, and a transverse osteotomy was performed at its center to achieve approximately 2 mm of shortening. Subsequently, fixation was performed using headless compression screws inserted from the proximal side. One screw was used in five wrists, and two screws were used in one wrist. The screw diameter was 2.4 mm in all cases (Fig. 1). The dorsal intercarpal ligament was repaired, and the wrist was immobilized with a cast for 6 weeks postoperatively. Figure 1. Pre- and post-operative radiographs showing wrist morphology before and after capitate shortening osteotomy. (A) Anteroposterior and lateral radiographs of the wrist before surgery in a patient with Kienböck disease. (B) Anteroposterior and lateral wrist radiographs after capitate shortening osteotomy in the same patient as in (A). Three-dimensional bone model analysis Three-dimensional CT scans were acquired using a 320-slice multidetector scanner with a wide field of view (Aquilion One; Canon Medical Systems, Tochigi, Japan). Scanning parameters included a slice thickness and interval of 0.5 mm, a 512 × 512 matrix, and a FOV of 500 mm. Three-dimensional (3D) bone models were generated from CT data obtained both before and after surgery with the palm facing downward in the prone position. Preoperative and 3-month postoperative wrist CT images were acquired, imported into the Digital Imaging and Communications in Medicine (DICOM) format, and segmented using specialized software (Mimics 21R, Materialize, Leuven, Belgium). The 3D reconstructions of the radius, ulna, scaphoid, lunate, capitate, trapezoid, trapezium, triquetrum, and hamate were then analyzed using custom software developed in the Microsoft Visual C + + programming environment (Microsoft, Redmond, WA, USA) [ 12 – 14 ]. The minimum distance distributions between the surfaces of the radius and scaphoid, as well as the radius and lunate, were calculated using a point-to-point distance calculation algorithm [ 15 ]. The articular contact areas were assessed using a custom-made software, which has been utilized in previous studies for the quantitative analysis of wrist and elbow joint mechanics [ 9 , 15 ]. The surface-to-surface least distance distributions between the radius and carpal bones and between the carpal bones were determined using a point-to-surface distance calculation algorithm implemented in a custom-written software. The articular contact areas were identified as regions where the least distance fell below a specified threshold. These distance thresholds were established based on previous studies examining distances within the wrist joint space, with a threshold of 2.0 mm for the radioscaphoid and radiolunate joints and 1.5 mm for the intercarpal joints [ 8 , 16 ]. The joint contact areas were computed from the 3D bone models using custom software. Additionally, the center of the contact area was determined, and the translation from the preoperative to postoperative state was calculated using custom software. To evaluate the translation of the contact area center, a validated 3D registration method was employed, and a transformation matrix from the preoperative to postoperative states was obtained [ 17 , 18 ]. The standard anatomical coordinate system for the wrist, as defined by the International Society of Biomechanics, was used (Fig. 2 ) [ 19 ]. The anatomical coordinate system of the wrist determines movements along three axes. The X-axis represents radial (+) and ulnar (–) directions, the Y-axis corresponds to dorsal (+) and volar (–) directions, and the Z-axis indicates distal (+) and proximal (–) directions. Statistical analysis The Wilcoxon matched-pair test was used to compare the pre- and post-operative groups. Statistical significance was set at P < 0.05. Owing to the small sample size, non-parametric tests were used as they do not assume normality and are suitable for paired data. Data are expressed as mean ± standard deviation, with corresponding 95% confidence intervals (CIs). RESULTS Demographic data of patients The study included six patients (three men and three women), classified into Lichtman stages II (3 wrists), IIIA (2 wrists), and IIIB (1 wrist), who underwent capitate shortening osteotomy for Kienböck disease. No additional procedures such as bone grafting, with or without a vascularized pedicle, were performed. The average age was 59.5 ± 9.2 years (range 46–67), with an average follow-up period of 32.7 ± 18.2 months (range 18.6–68.3) (Table 1 ). The average ulnar variance was 1.0 ± 1.4 mm (range 0–3.4). Table 1 Patient demographics Case Age (years, range) Affected hand Lichtman classification Ulnar variance (mm) Follow-up (months) 1 60–69 L Ⅱ 0 18.6 2 40–49 L Ⅲ 3.4 68.3 3 50–59 R ⅢA 1.1 25.9 4 50–59 L ⅢA 2 30 5 60–69 R Ⅱ 0 32.8 6 60–69 R ⅢA 0 20.7 Clinical outcomes and radiographic results The average VAS score improved from 5.8 ± 1.6 (95% CI, 4.1–7.5) preoperatively to 0.9 ± 1.0 (95% CI, − 0.1–1.9) at the last follow-up (P = 0.0312), whereas the MMWS improved from 52.5 ± 8.8 (95% CI, 43.3–61.7) to 81.7 ± 9.3 (95% CI, 71.9–91.5) (P = 0.0312). By MMWS, two cases were rated as excellent; three, good; and, one, satisfactory. The mean extension–flexion range of the wrist joint increased from 69.5 ± 7.8% (95% CI, 61.3–77.7) to 77.8 ± 11.0% (95% CI, 66.3–89.3), without statistical significance (Table 2 ). The CHR slightly decreased from a mean of 51.3 ± 5.5 (95% CI, 45.5–57.1) preoperatively to 48.9 ± 5.2 (95% CI, 43.4–54.4) postoperatively (P = 0.0625). No significant differences were observed in the Stahl indices. The radiography data reflected the impact of the shortened capitate height. Table 2 Patient clinical and radiographical results Case VAS MMWS ROM CHR S-I Pre Post Pre Post Pre Post Pre Post Pre Post 1 75 20 40 65 70 80 59.8 57.7 50.5 51.8 2 45 13 50 80 105 110 54.6 49.6 42.7 41.3 3 49 0 45 80 125 110 48.5 45 33.5 33.6 4 80 0 60 90 105 130 46.9 47.9 35.7 35.3 5 43 20 60 85 120 130 44.9 42.7 35.7 37.5 6 53 0 60 90 130 90 52.8 50.4 47.6 49.4 Mean 57.5 8.8 52.5 81.7 109.2 108.3 51.3 48.9 41.0 41.5 VAS: visual analog scale, MMWS: Modified Mayo Wrist Score, ROM: range of motion, CHR: carpal height ratio, S-I: Stahl’s index, Pre: pre-capitate shortening surgery, Post: post-capitate shortening surgery Joint contact area and translation of the center of joint contact area When the postoperative translation of the centroid of the radiolunate and radioscaphoid contact areas was analyzed, it was divided into radial, dorsal, and distal directions. The radial translation distance was 1.2 ± 1.2 mm (95% CI, − 0.1 to 2.5 mm); dorsal translation distance, 0.9 ± 1.0 mm (95% CI, − 0.3 to 2.0 mm); and, distal translation distance, − 0.1 ± 0.2 mm (95% CI, − 0.3 to 0.2 mm) (Fig. 3 ). This pattern indicates a tendency of the centroid to shift radially and dorsally. The centroids of the lunocapitate and scaphotrapezoid contact areas shifted dorsally after capitate shortening. The radiolunate joint contact area decreased significantly from 172.9 ± 45.4 mm² (95% CI, 136.5 to 209.3) preoperatively to 126.8 ± 40.7 mm² (95% CI, 94.7 to 158.9) postoperatively (P = 0.0312), and the lunocapitate joint contact area decreased significantly from 100.9 ± 45.7 mm² (95% CI, 52.9–148.9) preoperatively to 58.9 ± 38.8 mm² (95% CI, 26.7 to 91.2) postoperatively (P = 0.0312). Bone models and graphs showing changes in joint contact areas and the translation of their centroids before and after capitate shortening osteotomy. (A) Representative contact areas and centroids of the radiolunate and radioscaphoid regions are displayed on bone models. Preoperative and postoperative wrist joint contact areas are illustrated. Wide joint spaces are indicated in blue, whereas narrow joint spaces are marked in postoperative images in red. The black dot indicates the centroid of the contact area. (B) The graph shows postoperative centroid translation of the contact area in the radiolunate and radioscaphoid joints. (C) and (D) Representative contact areas and centroids of the lunocapitate joint and the graph showing postoperative centroid translation of the contact area in the lunocapitate joints are shown. (E) and (F) Representative contact areas and centroids of scaphotrapezium and scaphotrapezoid regions and the graph showing postoperative centroid translation of the contact area in the scaphotrapezoid joints are presented. In contrast, the scaphotrapezoid joint contact area increased significantly from 27.0 ± 22.5 mm² (95% CI, 9.0 to 45.0) preoperatively to 46.7 ± 25.6 mm² (95% CI, 26.7 to 66.8) postoperatively (P = 0.0312) (Fig. 4 ). Quantitative comparison of joint contact areas before and after capitate shortening osteotomy. Graphs showing changes in the contact area of multiple joint interfaces, including the radiolunate, radioscaphoid, scaphotrapezoid, and triquetrohamate joints, before and after capitate shortening surgery. *P < 0.05 compared with preoperative values. There was no significant difference in the contact area between the triquetrum and the hamate preoperatively and postoperatively. No significant correlations were observed between postoperative clinical scores or range of motion and the changes in articular contact areas (data not shown). In contrast, the lunate, scaphoid, and other carpal bones did not show consistent movement tendencies in the centroid translation distance (Fig. 5 ). Translation of the centroids of carpal bones after capitate shortening osteotomy. Graphs showing the postoperative translation of the centroid for the lunate, scaphoid, hamate, trapezium, and trapezoid. DISCUSSION We utilized 3D CT bone models to evaluate the changes in the contact area in vivo, before and after capitate shortening osteotomy. Previous analyses of changes in joint contact pressure following capitate shortening osteotomy have been conducted using cadaver studies and mathematical models, which have confirmed that contact pressure increases on the triquetrohamate and scaphotrapeziotrapezoidal joints [ 5 , 6 ]. In a cadaveric study using tendon loading, Viegas et al. demonstrated a nonlinear relationship between joint contact pressure and contact area in the wrist, indicating that changes in contact area can reflect changes in load distribution within the joint [ 20 ]. Based on this biomechanical insight, the radial increase in contact area observed in the present study indicates a redistribution of joint contact toward the radial side of the wrist after capitate shortening. Notably, as the CT images were acquired with patients in a relaxed, non–load-bearing condition without active muscle contraction, the use of in vivo imaging still provides clinically relevant insights into joint morphology and contact relationships under natural positioning. However, analyzing these changes under physiological conditions considering factors such as tendon balance remains challenging and has not yet been achieved. The 3D CT bone model–based approach employed in the present study may better approximate the actual biomechanical environment of the wrist. Similar to previous studies, this study confirmed that capitate shortening reduced the contact area involving the lunate and increased contact areas at surrounding joints, even under physiological conditions. However, in this study, the increase in contact area within the midcarpal joint on the ulnar side (triquetorumhamate joint) was minimal, with changes occurring predominantly on the radial side (Fig. 2 ). Considering the difference in the gaps between the radioscaphoid and ulnocarpal joints, it is reasonable to assume that contact tended to shift toward the radial side. Partial capitate shortening osteotomy has been proposed as an alternative decompression procedure for early-stage Kienböck disease. Its biomechanical behavior may differ from that of total capitate shortening because the osteotomy configuration and the preservation of the radial height of the capitate differ between the two procedures [ 21 ]. Therefore, the present findings obtained after total capitate shortening should not be directly extrapolated to partial capitate shortening procedures. Nevertheless, in a cadaveric model, Kataoka et al. demonstrated a 53% reduction in the load on the lunate and a 39% increase in the load on the radioscaphoid joint after partial capitate shortening [ 22 ]. However, whether partial capitate shortening provides more favorable radial load redistribution than total capitate shortening has not yet been established, and further investigation is required [ 23 ]. This study has certain limitations, including the use of CT imaging, which does not consider the dynamic effects of wrist motion, under non-load-bearing conditions. Factors such as finger grip and wrist posture can significantly influence the conditions within the wrist joint, and imaging under such functional conditions would provide a more comprehensive understanding of wrist load changes. However, in the absence of actual loading, motion simulation, or pressure data, any interpretation of load redistribution based solely on static contact areas remains speculative. The thresholds used to define contact areas were based on previous literature and reflect subchondral bone-to-bone proximity, as cartilage was not visualized during CT; thus, variations in cartilage thickness, degenerative changes, or joint incongruity may have influenced the accuracy of contact area estimations. In addition, although the sample size was limited and the anatomical variation of the lunate was not fully represented, Viegas classified lunates into Type 1, which does not articulate with the hamate, and Type 2, which does; Type 2 lunates are considered less responsive to capitate shortening osteotomy because the load transferred from the hamate may not decrease and could even increase. In this study, only one case involved a Type 2 lunate, and no apparent change in the radiolunate joint contact area was observed before and after surgery; however, given that this finding is based on a single case, its clinical significance remains uncertain [ 24 ]. Although no apparent morphological changes of the lunate were observed in postoperative images during the early follow-up period, and thus deformation due to osteonecrosis was not considered in the analysis, subtle cartilage wear or surface irregularities undetectable on CT may still have affected the accuracy of contact area measurements. In conclusion, using 3D CT bone models, we demonstrated postoperative changes in wrist joint contact distribution after capitate shortening osteotomy. These findings indicate a tendency toward radial redistribution of joint contact following the procedure, which may contribute to understanding the mechanical effects of capitate shortening in Kienböck disease. Abbreviations CT computed tomography VAS cisual analog scale MMWS Modified Mayo Wrist Score CHR carpal height ratio Declarations Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Acknowledgements We would like to thank Editage (www.editage.jp) for English language editing. Author Contributions D.M. contributed to the study conception and design. H.K., J.S., and Y.M. collected and analyzed the data. H.K. and D.M. wrote the first draft of the manuscript, and all authors commented on the previous versions. N.I. conceived the study and provided assistance. All the authors have read and approved the final version of the manuscript for publication. Competing interests The authors declare no competing interests. Consent for publication Not applicable. Availability of Data and Materials All data generated or analyzed during this study are included in this published article. Ethics approval and consent to participate The study was conducted in accordance with the guidelines of our Institution and was approved by our Institution Research Ethics Committee (approval ID:011-0327), and it conformed to the ethical standards of the 1975 Declaration of Helsinki. All participants provided written informed consent for use of their samples in this study. HIPAA consent was not applicable because this study was conducted outside the United States. References van Leeuwen WF, Pong TM, Gottlieb RW, Deml C, van der Chen N. Radial shortening osteotomy for symptomatic Kienböck's disease: Complications and long-term patient-reported outcome. J Wrist Surg. 2021;10:17–22. 10.1055/s-0040-1714750 . Kolovich GP, Kalu CMK, Ruff ME. Current trends in treatment of Kienbock disease: A survey of hand surgeons. Hand (N Y). 2016;11:113–8. 10.1177/1558944715616953 . Bain GI, Krishna SV, MacLean SBM, Agrawal P. Single-cut single-screw capitate-shortening osteotomy for Kienbock's disease. J Wrist Surg. 2020;9:276–82. 10.1055/s-0040-1709669 . Gay AM, Parratte S, Glard Y, Mutaftschiev N, Legre R. Isolated capitate shortening osteotomy for the early stage of Kienböck disease with neutral ulnar variance. Plast Reconstr Surg. 2009;124:560–6. 10.1097/PRS.0b013e3181addc50 . Horii E, Garcia-Elias M, Bishop AT, Cooney WP, Linscheid RL, Chao EY. Effect on force transmission across the carpus in procedures used to treat Kienböck's disease. J Hand Surg Am. 1990;15:393–400. 10.1016/0363-5023(90)90049-w . Werber KD, Schmelz R, Peimer CA, Wagenpfeil S, Machens HG, Lohmeyer JA. Biomechanical effect of isolated capitate shortening in Kienbock's disease: An anatomical study. J Hand Surg Eur Vol. 2013;38:500–7. 10.1177/1753193412458996 . Abe S, Oka K, Miyamura S, Shigi A, Tanaka H, Sugamoto K, et al. Three-dimensional in vivo analysis of malunited distal radius fractures with restricted forearm rotation. J Orthop Res. 2019;37:1881–91. 10.1002/jor.24332 . Kawanishi Y, Moritomo H, Omokawa S, Murase T, Sugamoto K, Yoshikawa H. In vivo 3-dimensional analysis of stage III Kienbock disease: Pattern of carpal deformity and radioscaphoid joint congruity. J Hand Surg Am. 2015;40:74–80. 10.1016/j.jhsa.2014.10.035 . Shiota J, Momma D, Matsui Y, Inoue N, Kondo E, Iwasaki N. Changes in wrist joint contact area following radial shortening osteotomy for Kienbock's disease. Sci Rep. 2022;12:4001. 10.1038/s41598-022-08027-0 . Youm Y, McMurthy RY, Flatt AE, Gillespie TE. Kinematics of the wrist. I. An experimental study of radial-ulnar deviation and flexion-extension. J Bone Joint Surg Am. 1978;60:423–31. Goldfarb CA, Hsu J, Gelberman RH, Boyer MI. The Lichtman classification for Kienböck's disease: An assessment of reliability. J Hand Surg Am. 2003;28:74–80. 10.1053/jhsu.2003.50035 . Irie T, Espinoza Orías AA, Irie TY, Nho SJ, Takahashi D, Iwasaki N, et al. Three-dimensional hip joint congruity evaluation of the borderline dysplasia: Zonal-acetabular radius of curvature. J Orthop Res. 2020;38:2197–205. 10.1002/jor.24631 . Irie T, Orías AAE, Irie TY, Nho SJ, Takahashi D, Iwasaki N, et al. Three-dimensional curvature mismatch of the acetabular radius to the femoral head radius is increased in borderline dysplastic hips. PLoS ONE. 2020;15:e0231001. 10.1371/journal.pone.0231001 . Irie T, Espinoza Orías AA, Irie TY, Nho SJ, Takahashi D, Iwasaki N, et al. Computed tomography-based three-dimensional analyses show similarities in anterosuperior acetabular coverage between acetabular dysplasia and borderline dysplasia. Arthroscopy. 2020;36:2623–32. 10.1016/j.arthro.2020.05.049 . Simon P, Espinoza Orías AA, Andersson GBJ, An HS, Inoue N. In vivo topographic analysis of lumbar facet joint space width distribution in healthy and symptomatic subjects. Spine. 2012;37:1058–64. 10.1097/BRS.0b013e3182552ec9 . Varga P, Schefzig P, Unger E, Mayr W, Zysset PK, Erhart J. Finite element based estimation of contact areas and pressures of the human scaphoid in various functional positions of the hand. J Biomech. 2013;46:984–90. 10.1016/j.jbiomech.2012.11.053 . Forsythe B, Lansdown D, Zuke WA, Verma NN, Cole BJ, Bach BR Jr., et al. Dynamic 3-dimensional mapping of isometric anterior cruciate ligament attachment sites on the tibia and femur: Is anatomic also isometric? Arthroscopy. 2018;34:2466–75. 10.1016/j.arthro.2018.03.033 . Forsythe B, Patel BH, Lansdown DA, Agarwalla A, Kunze KN, Lu Y, et al. Dynamic three-dimensional computed tomography mapping of isometric posterior cruciate ligament attachment sites on the tibia and femur: Single- versus double-bundle analysis. Arthroscopy. 2020;36:2875–84. 10.1016/j.arthro.2020.06.006 . van der Wu G, Veeger HEJD, Makhsous M, Van Roy P, Anglin C, et al. ISB recommendation on definitions of joint coordinate systems of various joints for the reporting of human joint motion–Part II: Shoulder, elbow, wrist and hand. J Biomech. 2005;38:981–92. 10.1016/j.jbiomech.2004.05.042 . Viegas SF, Patterson R, Peterson P, Roefs J, Tencer A, Choi S. The effects of various load paths and different loads on the load transfer characteristics of the wrist. J Hand Surg Am. 1989;14:458–65. 10.1016/S0363-5023(89)80004-8 . Moritomo H, Murase T, Yoshikawa H. Operative technique of a new decompression procedure for Kienböck disease: Partial capitate shortening. Tech Hand Up Extrem Surg. 2004;8:110–5. 10.1097/01.bth.0000126571.20944.47 . Kataoka T, Moritomo H, Omokawa S, Iida A, Wada T, Aoki M. Decompression effect of partial capitate shortening for Kienbock's disease: A biomechanical study. Hand Surg. 2012;17:299–305. 10.1142/s0218810412500219 . Erdoğan F, Pişkin A, Şener M. Comparison of partial and total capitate shortening osteotomies in the treatment of Lichtman stage 2–3A Kienböck’s disease. J Hand Surg Eur Vol. 2025;0:17531934251389713. 10.1177/17531934251389713 . Viegas SF, Wagner K, Patterson R, Peterson P. Medial (hamate) facet of the lunate. J Hand Surg Am. 1990;15:564–71. 10.1016/s0363-5023(09)90016-8 . Additional Declarations No competing interests reported. Supplementary Files Supplementarytable.xlsx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8938160","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":617829362,"identity":"9e536224-6a37-482b-988f-297c9adc51a9","order_by":0,"name":"Hideyuki Kobayashi","email":"","orcid":"","institution":"Hokkaido University","correspondingAuthor":false,"prefix":"","firstName":"Hideyuki","middleName":"","lastName":"Kobayashi","suffix":""},{"id":617829363,"identity":"2e8b49b3-1be8-4b54-bf76-6f16c7251b37","order_by":1,"name":"Daisuke Momma","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABAElEQVRIiWNgGAWjYDCCAxBKDogNmBkYEoAijA0gEWZCWoxJ15LYgNBCwF18B7gTH93MsUtf2968gbmgIi2x7/jhBoYfNQzs5ji0SB7g3Wycuy05d9uZYwXMM87kJM48k9jA2HOMgdmyAbsWg/tvt0nnbmPO3XYjx4CZt60iccMBoCN5GxiYDXC40OAAL0hLfbrZ/TdQLecfNjD+JazlcILZDR6QlpzEDTcSG5jx2QL1y3HDbWfSCg7znEkznnnjYcNhmWMSOP3Cd4B34+PcbdXyZscPb3zMU5Es23c+/eHDNzU2ybhCDAUcQGJIJBsQowUF2JGuZRSMglEwCoYpAAAVbmO7rhCR9gAAAABJRU5ErkJggg==","orcid":"","institution":"Hokkaido University","correspondingAuthor":true,"prefix":"","firstName":"Daisuke","middleName":"","lastName":"Momma","suffix":""},{"id":617829364,"identity":"57b3bb0e-3108-427b-a0cc-9744146273b2","order_by":2,"name":"Yuichiro Matsui","email":"","orcid":"","institution":"Hokkaido University","correspondingAuthor":false,"prefix":"","firstName":"Yuichiro","middleName":"","lastName":"Matsui","suffix":""},{"id":617829365,"identity":"000a013f-1655-4b19-8c51-659a04aa5838","order_by":3,"name":"Junki Shiota","email":"","orcid":"","institution":"Hokkaido University","correspondingAuthor":false,"prefix":"","firstName":"Junki","middleName":"","lastName":"Shiota","suffix":""},{"id":617829366,"identity":"9510a2ae-9347-4665-a6f7-0fd3a0a1d8e9","order_by":4,"name":"Norimasa Iwasaki","email":"","orcid":"","institution":"Hokkaido University","correspondingAuthor":false,"prefix":"","firstName":"Norimasa","middleName":"","lastName":"Iwasaki","suffix":""}],"badges":[],"createdAt":"2026-02-22 09:24:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8938160/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8938160/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106311146,"identity":"c5cecb4f-0d12-436b-bb55-a88e5808c6ef","added_by":"auto","created_at":"2026-04-07 10:28:29","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":1609991,"visible":true,"origin":"","legend":"\u003cp\u003ePre- and post-operative radiographs showing wrist morphology before and after capitate shortening osteotomy.\u003c/p\u003e\n\u003cp\u003e(A) Anteroposterior and lateral radiographs of the wrist before surgery in a patient with Kienböck disease. (B) Anteroposterior and lateral wrist radiographs after capitate shortening osteotomy in the same patient as in (A).\u003c/p\u003e","description":"","filename":"image1.png","url":"https://assets-eu.researchsquare.com/files/rs-8938160/v1/6c12df2b4644becfbc3a7fc4.png"},{"id":106311141,"identity":"a8b3b979-d7e7-4407-bbd2-a059e96748a7","added_by":"auto","created_at":"2026-04-07 10:28:29","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":213939,"visible":true,"origin":"","legend":"\u003cp\u003eThe anatomical coordinate system of the wrist determines movements along three axes.\u003c/p\u003e\n\u003cp\u003eThe X-axis represents radial (+) and ulnar (–) directions, the Y-axis corresponds to dorsal (+) and volar (–) directions, and the Z-axis indicates distal (+) and proximal (–) directions.\u003c/p\u003e","description":"","filename":"image2.png","url":"https://assets-eu.researchsquare.com/files/rs-8938160/v1/5d4d443a7e2120f8079249a1.png"},{"id":106311245,"identity":"fb4a7c04-4455-403a-b393-91d17dff361d","added_by":"auto","created_at":"2026-04-07 10:28:42","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":1442073,"visible":true,"origin":"","legend":"\u003cp\u003eBone models and graphs showing changes in joint contact areas and the translation of their centroids before and after capitate shortening osteotomy.\u003c/p\u003e\n\u003cp\u003e(A) Representative contact areas and centroids of the radiolunate and radioscaphoid regions are displayed on bone models. Preoperative and postoperative wrist joint contact areas are illustrated. Wide joint spaces are indicated in blue, whereas narrow joint spaces are marked in postoperative images in red. The black dot indicates the centroid of the contact area. (B) The graph shows postoperative centroid translation of the contact area in the radiolunate and radioscaphoid joints. (C) and (D) Representative contact areas and centroids of the lunocapitate joint and the graph showing postoperative centroid translation of the contact area in the lunocapitate joints are shown. (E) and (F) Representative contact areas and centroids of scaphotrapezium and scaphotrapezoid regions and the graph showing postoperative centroid translation of the contact area in the scaphotrapezoid joints are presented.\u003c/p\u003e","description":"","filename":"image3.png","url":"https://assets-eu.researchsquare.com/files/rs-8938160/v1/ab76148410a389e2cdf2b34e.png"},{"id":106311264,"identity":"20ba1090-fca2-4047-aec6-0889b8147bdf","added_by":"auto","created_at":"2026-04-07 10:28:49","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":628189,"visible":true,"origin":"","legend":"\u003cp\u003eQuantitative comparison of joint contact areas before and after capitate shortening osteotomy.\u003c/p\u003e\n\u003cp\u003eGraphs showing changes in the contact area of multiple joint interfaces, including the radiolunate, radioscaphoid, scaphotrapezoid, and triquetrohamate joints, before and after capitate shortening surgery. *P \u0026lt; 0.05 compared with preoperative values.\u003c/p\u003e","description":"","filename":"image4.png","url":"https://assets-eu.researchsquare.com/files/rs-8938160/v1/56f83733836c840ccb56357e.png"},{"id":106311148,"identity":"044b9664-c7da-4b31-a6f3-402065ed0275","added_by":"auto","created_at":"2026-04-07 10:28:29","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":538256,"visible":true,"origin":"","legend":"\u003cp\u003eTranslation of the centroids of carpal bones after capitate shortening osteotomy.\u003c/p\u003e\n\u003cp\u003eGraphs showing the postoperative translation of the centroid for the lunate, scaphoid, hamate, trapezium, and trapezoid.\u003c/p\u003e","description":"","filename":"image5.png","url":"https://assets-eu.researchsquare.com/files/rs-8938160/v1/435ffcf530762230dec7e34d.png"},{"id":109204434,"identity":"6bab1dea-a630-4c1c-8e35-85b4cd50d3fe","added_by":"auto","created_at":"2026-05-13 14:59:58","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":4655156,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8938160/v1/e13f98ad-be1c-4ed9-8c8d-6f7ef5b603a5.pdf"},{"id":106311263,"identity":"837a3071-e15a-490a-9f20-017468aa2dfe","added_by":"auto","created_at":"2026-04-07 10:28:49","extension":"xlsx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":14851,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementarytable.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-8938160/v1/499224b32571ab29d1385fcf.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Three-Dimensional Computed Tomography-based Analysis of Joint Contact Area Changes After Capitate Shortening Osteotomy in Kienböck Disease: A Retrospective Case Series","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eKienb\u0026ouml;ck disease is characterized by necrosis of the lunate bone. Various clinical studies have indicated a positive correlation between the incidence of Kienb\u0026ouml;ck disease and ulnar variance, indicating that a relatively longer radius exerts excessive force on the lunate bone, leading to vascular necrosis [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. However, not all cases of Kienb\u0026ouml;ck disease exhibit negative ulnar variance, and its exact etiology remains unclear.\u003c/p\u003e \u003cp\u003eVarious surgical procedures have been reported depending on the stage of Kienb\u0026ouml;ck disease. Capitate shortening osteotomy provides significant pain relief and revascularization of the lunate bone in patients with neutral or positive ulnar variance [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Capitate shortening osteotomy distributes the load on the lunate to the adjacent carpal bones; however, changes in the biological environment remain underexplored [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Changes in the wrist contact area have been reported in Kienb\u0026ouml;ck disease, indicating that the mechanical load on the wrist can be understood by measuring the wrist contact pattern [\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWe hypothesized that capitate shortening osteotomy would change the contact area of the wrist joint. This study aimed to evaluate the contact area of the wrist in Kienb\u0026ouml;ck disease before and after capitate shortening osteotomy and examine the mechanical changes resulting from surgery.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003ePatients\u003c/h2\u003e \u003cp\u003eThis study retrospectively analyzed patients who underwent capitate shortening osteotomy for Kienb\u0026ouml;ck disease. A total of 7 patients underwent the procedure between 2011 and 2017. One case without postoperative computed tomography (CT) data was excluded, leaving 6 patients for analysis. No additional exclusion criteria were applied other than the availability of postoperative CT data. The cases were collected from two hospitals, and the surgeries were performed by multiple surgeons. Data of CT, plain radiography, and clinical assessments before and after surgery were collected. To evaluate pre- and post-operative pain and wrist range of motion, the Visual Analog Scale (VAS) and Modified Mayo Wrist Scoring System (MMWS) were employed. The carpal height ratio (CHR) and Stahl index were calculated using radiographs [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. This study was reported in accordance with the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSurgical technique\u003c/h3\u003e\n\u003cp\u003eThe surgical procedure has been previously described in detail [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Briefly, a longitudinal skin incision of approximately 3 cm was made over the dorsal aspect of the capitate. The extensor tendons were retracted, and the wrist joint capsule, along with the dorsal intercarpal ligament were incised longitudinally. The capitate was exposed, and a transverse osteotomy was performed at its center to achieve approximately 2 mm of shortening. Subsequently, fixation was performed using headless compression screws inserted from the proximal side. One screw was used in five wrists, and two screws were used in one wrist. The screw diameter was 2.4 mm in all cases (Fig.\u0026nbsp;1). The dorsal intercarpal ligament was repaired, and the wrist was immobilized with a cast for 6 weeks postoperatively. \u003cdiv description=\"\" class=\"Drawing\" id=\"1166090449\" name=\"図 1\"\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e \u003cb\u003eFigure 1.\u003c/b\u003e \u003c/p\u003e \u003cp\u003ePre- and post-operative radiographs showing wrist morphology before and after capitate shortening osteotomy.\u003c/p\u003e \u003cp\u003e(A) Anteroposterior and lateral radiographs of the wrist before surgery in a patient with Kienb\u0026ouml;ck disease. (B) Anteroposterior and lateral wrist radiographs after capitate shortening osteotomy in the same patient as in (A).\u003c/p\u003e\n\u003ch3\u003eThree-dimensional bone model analysis\u003c/h3\u003e\n\u003cp\u003eThree-dimensional CT scans were acquired using a 320-slice multidetector scanner with a wide field of view (Aquilion One; Canon Medical Systems, Tochigi, Japan). Scanning parameters included a slice thickness and interval of 0.5 mm, a 512 \u0026times; 512 matrix, and a FOV of 500 mm. Three-dimensional (3D) bone models were generated from CT data obtained both before and after surgery with the palm facing downward in the prone position. Preoperative and 3-month postoperative wrist CT images were acquired, imported into the Digital Imaging and Communications in Medicine (DICOM) format, and segmented using specialized software (Mimics 21R, Materialize, Leuven, Belgium). The 3D reconstructions of the radius, ulna, scaphoid, lunate, capitate, trapezoid, trapezium, triquetrum, and hamate were then analyzed using custom software developed in the Microsoft Visual C\u0026thinsp;+\u0026thinsp;+\u0026thinsp;programming environment (Microsoft, Redmond, WA, USA) [\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The minimum distance distributions between the surfaces of the radius and scaphoid, as well as the radius and lunate, were calculated using a point-to-point distance calculation algorithm [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The articular contact areas were assessed using a custom-made software, which has been utilized in previous studies for the quantitative analysis of wrist and elbow joint mechanics [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe surface-to-surface least distance distributions between the radius and carpal bones and between the carpal bones were determined using a point-to-surface distance calculation algorithm implemented in a custom-written software. The articular contact areas were identified as regions where the least distance fell below a specified threshold. These distance thresholds were established based on previous studies examining distances within the wrist joint space, with a threshold of 2.0 mm for the radioscaphoid and radiolunate joints and 1.5 mm for the intercarpal joints [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The joint contact areas were computed from the 3D bone models using custom software. Additionally, the center of the contact area was determined, and the translation from the preoperative to postoperative state was calculated using custom software. To evaluate the translation of the contact area center, a validated 3D registration method was employed, and a transformation matrix from the preoperative to postoperative states was obtained [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The standard anatomical coordinate system for the wrist, as defined by the International Society of Biomechanics, was used (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e2\u003c/span\u003e) [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe anatomical coordinate system of the wrist determines movements along three axes.\u003c/p\u003e \u003cp\u003eThe X-axis represents radial (+) and ulnar (\u0026ndash;) directions, the Y-axis corresponds to dorsal (+) and volar (\u0026ndash;) directions, and the Z-axis indicates distal (+) and proximal (\u0026ndash;) directions.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eThe Wilcoxon matched-pair test was used to compare the pre- and post-operative groups. Statistical significance was set at P\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Owing to the small sample size, non-parametric tests were used as they do not assume normality and are suitable for paired data. Data are expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation, with corresponding 95% confidence intervals (CIs).\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eDemographic data of patients\u003c/h2\u003e \u003cp\u003eThe study included six patients (three men and three women), classified into Lichtman stages II (3 wrists), IIIA (2 wrists), and IIIB (1 wrist), who underwent capitate shortening osteotomy for Kienb\u0026ouml;ck disease. No additional procedures such as bone grafting, with or without a vascularized pedicle, were performed. The average age was 59.5\u0026thinsp;\u0026plusmn;\u0026thinsp;9.2 years (range 46\u0026ndash;67), with an average follow-up period of 32.7\u0026thinsp;\u0026plusmn;\u0026thinsp;18.2 months (range 18.6\u0026ndash;68.3) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The average ulnar variance was 1.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4 mm (range 0\u0026ndash;3.4).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePatient demographics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCase\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003cp\u003e(years, range)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAffected\u003c/p\u003e \u003cp\u003ehand\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLichtman\u003c/p\u003e \u003cp\u003eclassification\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUlnar variance\u003c/p\u003e \u003cp\u003e(mm)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eFollow-up\u003c/p\u003e \u003cp\u003e(months)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60\u0026ndash;69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eⅡ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e18.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40\u0026ndash;49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eⅢ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e68.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50\u0026ndash;59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eⅢA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e25.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50\u0026ndash;59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eⅢA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60\u0026ndash;69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eⅡ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e32.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60\u0026ndash;69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eⅢA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e20.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eClinical outcomes and radiographic results\u003c/h3\u003e\n\u003cp\u003eThe average VAS score improved from 5.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6 (95% CI, 4.1\u0026ndash;7.5) preoperatively to 0.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0 (95% CI, \u0026minus;\u0026thinsp;0.1\u0026ndash;1.9) at the last follow-up (P\u0026thinsp;=\u0026thinsp;0.0312), whereas the MMWS improved from 52.5\u0026thinsp;\u0026plusmn;\u0026thinsp;8.8 (95% CI, 43.3\u0026ndash;61.7) to 81.7\u0026thinsp;\u0026plusmn;\u0026thinsp;9.3 (95% CI, 71.9\u0026ndash;91.5) (P\u0026thinsp;=\u0026thinsp;0.0312). By MMWS, two cases were rated as excellent; three, good; and, one, satisfactory. The mean extension\u0026ndash;flexion range of the wrist joint increased from 69.5\u0026thinsp;\u0026plusmn;\u0026thinsp;7.8% (95% CI, 61.3\u0026ndash;77.7) to 77.8\u0026thinsp;\u0026plusmn;\u0026thinsp;11.0% (95% CI, 66.3\u0026ndash;89.3), without statistical significance (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The CHR slightly decreased from a mean of 51.3\u0026thinsp;\u0026plusmn;\u0026thinsp;5.5 (95% CI, 45.5\u0026ndash;57.1) preoperatively to 48.9\u0026thinsp;\u0026plusmn;\u0026thinsp;5.2 (95% CI, 43.4\u0026ndash;54.4) postoperatively (P\u0026thinsp;=\u0026thinsp;0.0625). No significant differences were observed in the Stahl indices. The radiography data reflected the impact of the shortened capitate height.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePatient clinical and radiographical results\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"16\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c15\" colnum=\"15\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c16\" colnum=\"16\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCase\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eVAS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eMMWS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003eROM\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e \u003cp\u003eCHR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003eS-I\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePre\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePost\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePre\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ePost\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003ePre\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003ePost\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003ePre\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c13\"\u003e \u003cp\u003ePost\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c15\"\u003e \u003cp\u003ePre\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c16\"\u003e \u003cp\u003ePost\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e59.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e57.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c15\"\u003e \u003cp\u003e50.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c16\"\u003e \u003cp\u003e51.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e54.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e49.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c15\"\u003e \u003cp\u003e42.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c16\"\u003e \u003cp\u003e41.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e48.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c15\"\u003e \u003cp\u003e33.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c16\"\u003e \u003cp\u003e33.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e130\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e46.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e47.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c15\"\u003e \u003cp\u003e35.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c16\"\u003e \u003cp\u003e35.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e130\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e44.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e42.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c15\"\u003e \u003cp\u003e35.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c16\"\u003e \u003cp\u003e37.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e130\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e52.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e50.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c15\"\u003e \u003cp\u003e47.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c16\"\u003e \u003cp\u003e49.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e52.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e81.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e109.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e108.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e51.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e48.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c15\"\u003e \u003cp\u003e41.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c16\"\u003e \u003cp\u003e41.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eVAS: visual analog scale, MMWS: Modified Mayo Wrist Score, ROM: range of motion, CHR: carpal height ratio, S-I: Stahl\u0026rsquo;s index, Pre: pre-capitate shortening surgery, Post: post-capitate shortening surgery\u003c/p\u003e\n\u003ch3\u003eJoint contact area and translation of the center of joint contact area\u003c/h3\u003e\n\u003cp\u003eWhen the postoperative translation of the centroid of the radiolunate and radioscaphoid contact areas was analyzed, it was divided into radial, dorsal, and distal directions. The radial translation distance was 1.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2 mm (95% CI, \u0026minus;\u0026thinsp;0.1 to 2.5 mm); dorsal translation distance, 0.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0 mm (95% CI, \u0026minus;\u0026thinsp;0.3 to 2.0 mm); and, distal translation distance, \u0026minus;\u0026thinsp;0.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2 mm (95% CI, \u0026minus;\u0026thinsp;0.3 to 0.2 mm) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e3\u003c/span\u003e). This pattern indicates a tendency of the centroid to shift radially and dorsally. The centroids of the lunocapitate and scaphotrapezoid contact areas shifted dorsally after capitate shortening. The radiolunate joint contact area decreased significantly from 172.9\u0026thinsp;\u0026plusmn;\u0026thinsp;45.4 mm\u0026sup2; (95% CI, 136.5 to 209.3) preoperatively to 126.8\u0026thinsp;\u0026plusmn;\u0026thinsp;40.7 mm\u0026sup2; (95% CI, 94.7 to 158.9) postoperatively (P\u0026thinsp;=\u0026thinsp;0.0312), and the lunocapitate joint contact area decreased significantly from 100.9\u0026thinsp;\u0026plusmn;\u0026thinsp;45.7 mm\u0026sup2; (95% CI, 52.9\u0026ndash;148.9) preoperatively to 58.9\u0026thinsp;\u0026plusmn;\u0026thinsp;38.8 mm\u0026sup2; (95% CI, 26.7 to 91.2) postoperatively (P\u0026thinsp;=\u0026thinsp;0.0312).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eBone models and graphs showing changes in joint contact areas and the translation of their centroids before and after capitate shortening osteotomy.\u003c/p\u003e \u003cp\u003e(A) Representative contact areas and centroids of the radiolunate and radioscaphoid regions are displayed on bone models. Preoperative and postoperative wrist joint contact areas are illustrated. Wide joint spaces are indicated in blue, whereas narrow joint spaces are marked in postoperative images in red. The black dot indicates the centroid of the contact area. (B) The graph shows postoperative centroid translation of the contact area in the radiolunate and radioscaphoid joints. (C) and (D) Representative contact areas and centroids of the lunocapitate joint and the graph showing postoperative centroid translation of the contact area in the lunocapitate joints are shown. (E) and (F) Representative contact areas and centroids of scaphotrapezium and scaphotrapezoid regions and the graph showing postoperative centroid translation of the contact area in the scaphotrapezoid joints are presented.\u003c/p\u003e \u003cp\u003eIn contrast, the scaphotrapezoid joint contact area increased significantly from 27.0\u0026thinsp;\u0026plusmn;\u0026thinsp;22.5 mm\u0026sup2; (95% CI, 9.0 to 45.0) preoperatively to 46.7\u0026thinsp;\u0026plusmn;\u0026thinsp;25.6 mm\u0026sup2; (95% CI, 26.7 to 66.8) postoperatively (P\u0026thinsp;=\u0026thinsp;0.0312) (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eQuantitative comparison of joint contact areas before and after capitate shortening osteotomy.\u003c/p\u003e \u003cp\u003eGraphs showing changes in the contact area of multiple joint interfaces, including the radiolunate, radioscaphoid, scaphotrapezoid, and triquetrohamate joints, before and after capitate shortening surgery. *P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 compared with preoperative values.\u003c/p\u003e \u003cp\u003eThere was no significant difference in the contact area between the triquetrum and the hamate preoperatively and postoperatively. No significant correlations were observed between postoperative clinical scores or range of motion and the changes in articular contact areas (data not shown). In contrast, the lunate, scaphoid, and other carpal bones did not show consistent movement tendencies in the centroid translation distance (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eTranslation of the centroids of carpal bones after capitate shortening osteotomy.\u003c/p\u003e \u003cp\u003eGraphs showing the postoperative translation of the centroid for the lunate, scaphoid, hamate, trapezium, and trapezoid.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eWe utilized 3D CT bone models to evaluate the changes in the contact area in vivo, before and after capitate shortening osteotomy. Previous analyses of changes in joint contact pressure following capitate shortening osteotomy have been conducted using cadaver studies and mathematical models, which have confirmed that contact pressure increases on the triquetrohamate and scaphotrapeziotrapezoidal joints [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. In a cadaveric study using tendon loading, Viegas et al. demonstrated a nonlinear relationship between joint contact pressure and contact area in the wrist, indicating that changes in contact area can reflect changes in load distribution within the joint [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Based on this biomechanical insight, the radial increase in contact area observed in the present study indicates a redistribution of joint contact toward the radial side of the wrist after capitate shortening. Notably, as the CT images were acquired with patients in a relaxed, non\u0026ndash;load-bearing condition without active muscle contraction, the use of in vivo imaging still provides clinically relevant insights into joint morphology and contact relationships under natural positioning. However, analyzing these changes under physiological conditions considering factors such as tendon balance remains challenging and has not yet been achieved. The 3D CT bone model\u0026ndash;based approach employed in the present study may better approximate the actual biomechanical environment of the wrist.\u003c/p\u003e \u003cp\u003eSimilar to previous studies, this study confirmed that capitate shortening reduced the contact area involving the lunate and increased contact areas at surrounding joints, even under physiological conditions. However, in this study, the increase in contact area within the midcarpal joint on the ulnar side (triquetorumhamate joint) was minimal, with changes occurring predominantly on the radial side (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Considering the difference in the gaps between the radioscaphoid and ulnocarpal joints, it is reasonable to assume that contact tended to shift toward the radial side.\u003c/p\u003e \u003cp\u003ePartial capitate shortening osteotomy has been proposed as an alternative decompression procedure for early-stage Kienb\u0026ouml;ck disease. Its biomechanical behavior may differ from that of total capitate shortening because the osteotomy configuration and the preservation of the radial height of the capitate differ between the two procedures [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Therefore, the present findings obtained after total capitate shortening should not be directly extrapolated to partial capitate shortening procedures. Nevertheless, in a cadaveric model, Kataoka et al. demonstrated a 53% reduction in the load on the lunate and a 39% increase in the load on the radioscaphoid joint after partial capitate shortening [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. However, whether partial capitate shortening provides more favorable radial load redistribution than total capitate shortening has not yet been established, and further investigation is required [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study has certain limitations, including the use of CT imaging, which does not consider the dynamic effects of wrist motion, under non-load-bearing conditions. Factors such as finger grip and wrist posture can significantly influence the conditions within the wrist joint, and imaging under such functional conditions would provide a more comprehensive understanding of wrist load changes. However, in the absence of actual loading, motion simulation, or pressure data, any interpretation of load redistribution based solely on static contact areas remains speculative. The thresholds used to define contact areas were based on previous literature and reflect subchondral bone-to-bone proximity, as cartilage was not visualized during CT; thus, variations in cartilage thickness, degenerative changes, or joint incongruity may have influenced the accuracy of contact area estimations. In addition, although the sample size was limited and the anatomical variation of the lunate was not fully represented, Viegas classified lunates into Type 1, which does not articulate with the hamate, and Type 2, which does; Type 2 lunates are considered less responsive to capitate shortening osteotomy because the load transferred from the hamate may not decrease and could even increase. In this study, only one case involved a Type 2 lunate, and no apparent change in the radiolunate joint contact area was observed before and after surgery; however, given that this finding is based on a single case, its clinical significance remains uncertain [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Although no apparent morphological changes of the lunate were observed in postoperative images during the early follow-up period, and thus deformation due to osteonecrosis was not considered in the analysis, subtle cartilage wear or surface irregularities undetectable on CT may still have affected the accuracy of contact area measurements.\u003c/p\u003e \u003cp\u003eIn conclusion, using 3D CT bone models, we demonstrated postoperative changes in wrist joint contact distribution after capitate shortening osteotomy. These findings indicate a tendency toward radial redistribution of joint contact following the procedure, which may contribute to understanding the mechanical effects of capitate shortening in Kienb\u0026ouml;ck disease.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ecomputed tomography\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eVAS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ecisual analog scale\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMMWS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eModified Mayo Wrist Score\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCHR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ecarpal height ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eWe would like to thank Editage (www.editage.jp) for English language editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eD.M. contributed to the study conception and design. H.K., J.S., and Y.M. collected and analyzed the data. H.K. and D.M. wrote the first draft of the manuscript, and all authors commented on the previous versions. N.I. conceived the study and provided assistance. All the authors have read and approved the final version of the manuscript for publication.\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003eAvailability of Data and Materials\u003c/p\u003e\n\u003cp\u003eAll data generated or analyzed during this study are included in this published article.\u003c/p\u003e\n\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eThe study was conducted in accordance with the guidelines of our Institution and was approved by our Institution Research Ethics Committee (approval ID:011-0327), and it conformed to the ethical standards of the 1975 Declaration of Helsinki. All participants provided written informed consent for use of their samples in this study. HIPAA consent was not applicable because this study was conducted outside the United States.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003evan Leeuwen WF, Pong TM, Gottlieb RW, Deml C, van der Chen N. Radial shortening osteotomy for symptomatic Kienb\u0026ouml;ck's disease: Complications and long-term patient-reported outcome. J Wrist Surg. 2021;10:17\u0026ndash;22. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1055/s-0040-1714750\u003c/span\u003e\u003cspan address=\"10.1055/s-0040-1714750\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKolovich GP, Kalu CMK, Ruff ME. Current trends in treatment of Kienbock disease: A survey of hand surgeons. Hand (N Y). 2016;11:113\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/1558944715616953\u003c/span\u003e\u003cspan address=\"10.1177/1558944715616953\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBain GI, Krishna SV, MacLean SBM, Agrawal P. Single-cut single-screw capitate-shortening osteotomy for Kienbock's disease. J Wrist Surg. 2020;9:276\u0026ndash;82. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1055/s-0040-1709669\u003c/span\u003e\u003cspan address=\"10.1055/s-0040-1709669\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGay AM, Parratte S, Glard Y, Mutaftschiev N, Legre R. Isolated capitate shortening osteotomy for the early stage of Kienb\u0026ouml;ck disease with neutral ulnar variance. Plast Reconstr Surg. 2009;124:560\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/PRS.0b013e3181addc50\u003c/span\u003e\u003cspan address=\"10.1097/PRS.0b013e3181addc50\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHorii E, Garcia-Elias M, Bishop AT, Cooney WP, Linscheid RL, Chao EY. Effect on force transmission across the carpus in procedures used to treat Kienb\u0026ouml;ck's disease. J Hand Surg Am. 1990;15:393\u0026ndash;400. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/0363-5023(90)90049-w\u003c/span\u003e\u003cspan address=\"10.1016/0363-5023(90)90049-w\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWerber KD, Schmelz R, Peimer CA, Wagenpfeil S, Machens HG, Lohmeyer JA. Biomechanical effect of isolated capitate shortening in Kienbock's disease: An anatomical study. J Hand Surg Eur Vol. 2013;38:500\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/1753193412458996\u003c/span\u003e\u003cspan address=\"10.1177/1753193412458996\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbe S, Oka K, Miyamura S, Shigi A, Tanaka H, Sugamoto K, et al. Three-dimensional in vivo analysis of malunited distal radius fractures with restricted forearm rotation. J Orthop Res. 2019;37:1881\u0026ndash;91. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/jor.24332\u003c/span\u003e\u003cspan address=\"10.1002/jor.24332\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKawanishi Y, Moritomo H, Omokawa S, Murase T, Sugamoto K, Yoshikawa H. In vivo 3-dimensional analysis of stage III Kienbock disease: Pattern of carpal deformity and radioscaphoid joint congruity. J Hand Surg Am. 2015;40:74\u0026ndash;80. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jhsa.2014.10.035\u003c/span\u003e\u003cspan address=\"10.1016/j.jhsa.2014.10.035\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShiota J, Momma D, Matsui Y, Inoue N, Kondo E, Iwasaki N. Changes in wrist joint contact area following radial shortening osteotomy for Kienbock's disease. Sci Rep. 2022;12:4001. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1038/s41598-022-08027-0\u003c/span\u003e\u003cspan address=\"10.1038/s41598-022-08027-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYoum Y, McMurthy RY, Flatt AE, Gillespie TE. Kinematics of the wrist. I. An experimental study of radial-ulnar deviation and flexion-extension. J Bone Joint Surg Am. 1978;60:423\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGoldfarb CA, Hsu J, Gelberman RH, Boyer MI. The Lichtman classification for Kienb\u0026ouml;ck's disease: An assessment of reliability. J Hand Surg Am. 2003;28:74\u0026ndash;80. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1053/jhsu.2003.50035\u003c/span\u003e\u003cspan address=\"10.1053/jhsu.2003.50035\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIrie T, Espinoza Or\u0026iacute;as AA, Irie TY, Nho SJ, Takahashi D, Iwasaki N, et al. Three-dimensional hip joint congruity evaluation of the borderline dysplasia: Zonal-acetabular radius of curvature. J Orthop Res. 2020;38:2197\u0026ndash;205. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/jor.24631\u003c/span\u003e\u003cspan address=\"10.1002/jor.24631\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIrie T, Or\u0026iacute;as AAE, Irie TY, Nho SJ, Takahashi D, Iwasaki N, et al. Three-dimensional curvature mismatch of the acetabular radius to the femoral head radius is increased in borderline dysplastic hips. PLoS ONE. 2020;15:e0231001. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1371/journal.pone.0231001\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0231001\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIrie T, Espinoza Or\u0026iacute;as AA, Irie TY, Nho SJ, Takahashi D, Iwasaki N, et al. Computed tomography-based three-dimensional analyses show similarities in anterosuperior acetabular coverage between acetabular dysplasia and borderline dysplasia. Arthroscopy. 2020;36:2623\u0026ndash;32. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.arthro.2020.05.049\u003c/span\u003e\u003cspan address=\"10.1016/j.arthro.2020.05.049\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSimon P, Espinoza Or\u0026iacute;as AA, Andersson GBJ, An HS, Inoue N. In vivo topographic analysis of lumbar facet joint space width distribution in healthy and symptomatic subjects. Spine. 2012;37:1058\u0026ndash;64. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/BRS.0b013e3182552ec9\u003c/span\u003e\u003cspan address=\"10.1097/BRS.0b013e3182552ec9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVarga P, Schefzig P, Unger E, Mayr W, Zysset PK, Erhart J. Finite element based estimation of contact areas and pressures of the human scaphoid in various functional positions of the hand. J Biomech. 2013;46:984\u0026ndash;90. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jbiomech.2012.11.053\u003c/span\u003e\u003cspan address=\"10.1016/j.jbiomech.2012.11.053\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eForsythe B, Lansdown D, Zuke WA, Verma NN, Cole BJ, Bach BR Jr., et al. Dynamic 3-dimensional mapping of isometric anterior cruciate ligament attachment sites on the tibia and femur: Is anatomic also isometric? Arthroscopy. 2018;34:2466\u0026ndash;75. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.arthro.2018.03.033\u003c/span\u003e\u003cspan address=\"10.1016/j.arthro.2018.03.033\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eForsythe B, Patel BH, Lansdown DA, Agarwalla A, Kunze KN, Lu Y, et al. Dynamic three-dimensional computed tomography mapping of isometric posterior cruciate ligament attachment sites on the tibia and femur: Single- versus double-bundle analysis. Arthroscopy. 2020;36:2875\u0026ndash;84. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.arthro.2020.06.006\u003c/span\u003e\u003cspan address=\"10.1016/j.arthro.2020.06.006\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003evan der Wu G, Veeger HEJD, Makhsous M, Van Roy P, Anglin C, et al. ISB recommendation on definitions of joint coordinate systems of various joints for the reporting of human joint motion\u0026ndash;Part II: Shoulder, elbow, wrist and hand. J Biomech. 2005;38:981\u0026ndash;92. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jbiomech.2004.05.042\u003c/span\u003e\u003cspan address=\"10.1016/j.jbiomech.2004.05.042\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eViegas SF, Patterson R, Peterson P, Roefs J, Tencer A, Choi S. The effects of various load paths and different loads on the load transfer characteristics of the wrist. J Hand Surg Am. 1989;14:458\u0026ndash;65. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/S0363-5023(89)80004-8\u003c/span\u003e\u003cspan address=\"10.1016/S0363-5023(89)80004-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoritomo H, Murase T, Yoshikawa H. Operative technique of a new decompression procedure for Kienb\u0026ouml;ck disease: Partial capitate shortening. Tech Hand Up Extrem Surg. 2004;8:110\u0026ndash;5. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/01.bth.0000126571.20944.47\u003c/span\u003e\u003cspan address=\"10.1097/01.bth.0000126571.20944.47\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKataoka T, Moritomo H, Omokawa S, Iida A, Wada T, Aoki M. Decompression effect of partial capitate shortening for Kienbock's disease: A biomechanical study. Hand Surg. 2012;17:299\u0026ndash;305. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1142/s0218810412500219\u003c/span\u003e\u003cspan address=\"10.1142/s0218810412500219\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eErdoğan F, Pişkin A, Şener M. Comparison of partial and total capitate shortening osteotomies in the treatment of Lichtman stage 2\u0026ndash;3A Kienb\u0026ouml;ck\u0026rsquo;s disease. J Hand Surg Eur Vol. 2025;0:17531934251389713. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/17531934251389713\u003c/span\u003e\u003cspan address=\"10.1177/17531934251389713\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eViegas SF, Wagner K, Patterson R, Peterson P. Medial (hamate) facet of the lunate. J Hand Surg Am. 1990;15:564\u0026ndash;71. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/s0363-5023(09)90016-8\u003c/span\u003e\u003cspan address=\"10.1016/s0363-5023(09)90016-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Kienböck disease, Capitate shortening osteotomy, Wrist joint, Contact area, Three-dimensional computed tomography, Biomechanics","lastPublishedDoi":"10.21203/rs.3.rs-8938160/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8938160/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo evaluate changes in wrist joint contact after capitate-shortening osteotomy for Kienböck disease using in-vivo three-dimensional (3D) computed tomography-based bone models.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn a multicenter retrospective case series, six wrists of six patients undergoing isolated capitate-shortening osteotomy for Kienböck disease were analyzed. Pre- and postoperative CT datasets were reconstructed into patient-specific bone models. Contact areas between the radius and carpal bones and among intercarpal joints were quantified, and contact-centroid locations were computed to evaluate the spatial redistribution of load. The primary outcomes were radiolunate, radioscaphoid, and lunocapitate contact areas, and the secondary outcomes were centroid shifts indicating the direction of load transfer.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSix patients were classified as Lichtman stage II (3 wrists), IIIA (2 wrists), and IIIB (1 wrist); all showed significant improvements in VAS and MMWS during follow-up. Postoperatively, radiolunate and lunocapitate contact areas decreased, whereas the radioscaphoid contact area increased; these changes were statistically significant. The centroid analysis revealed a dorsoradial shift at the radioscaphoid region and a palmar shift at the lunocapitate region.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCapitate-shortening osteotomy was associated with decreased radiolunate and lunocapitate contact areas and increased radioscaphoid contact area on three-dimensional CT-based models. These findings support the rationale for capitate shortening as a procedure that influences wrist joint contact patterns in Kienböck disease and provide objective imaging metrics that may aid postoperative evaluation and future comparative studies.\u003c/p\u003e\n\u003cp\u003eClinical trial number:Not applicable.\u003c/p\u003e","manuscriptTitle":"Three-Dimensional Computed Tomography-based Analysis of Joint Contact Area Changes After Capitate Shortening Osteotomy in Kienböck Disease: A Retrospective Case Series","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-07 10:27:29","doi":"10.21203/rs.3.rs-8938160/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a383d55f-16e2-47f2-8116-697da44129ec","owner":[],"postedDate":"April 7th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-05-12T08:45:32+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-07 10:27:29","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8938160","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8938160","identity":"rs-8938160","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}