title: Pyrocarbon interposition arthroplasty for proximal capitate avascular necrosis.
abstract: BACKGROUND
  Avascular necrosis of the capitate head is a rare condition commonly treated with partial wrist fusion. Although good functional results are usually reported, a degree of stiffness is to be expected. We report a pyrocarbon interposition arthroplasty technique in a young sportsman with 3.5 years of follow-up.
  
  
  METHODS
  A 15-year-old rugby player presented with a 6-month history of wrist pain and stiffness with no preceding injury. The necrotic bone was replaced with interposition of a pyrocarbon interposition implant (PI(2)) (Tournier, Grenoble, France), originally designed to replace the trapezium. A concave socket was created in the distal fragment to accommodate the implant and prevent dislocation. Regular follow-up included subjective and objective measures.
  
  
  RESULTS
  He was pain free by 6 weeks and regained good functional range of motion and grip strength by 3 months. He returned to playing rugby at the 1-year follow-up. At 2 years, he remained asymptomatic. After 3.5 years, he had no limitations in his heavy manual work as a plant mechanic and retained a good functional range of motion including the dart-thrower's motion.
  
  
  CONCLUSIONS
  Medium-term results appear to offer the benefits of being able to return to heavy manual labour as well as retaining a functional range of motion. It is difficult to predict long-term survival, but the outcome so far is encouraging, and conversion to midcarpal fusion remains a salvage option.
authors.affiliation: Trauma & Orthopaedics Department, The Royal Cornwall Hospital, Treliske, Truro, Cornwall TR1 3LJ UK ; 16 College View, Plymouth, PL3 4JB UK.
authors.forename: Nikolas A
authors.initials: NA
authors.lastname: Jagodzinski
authors.affiliation: Trauma & Orthopaedics Department, The Royal Cornwall Hospital, Treliske, Truro, Cornwall TR1 3LJ UK.
authors.forename: Clare F
authors.initials: CF
authors.lastname: Taylor
authors.affiliation: Trauma & Orthopaedics Department, The Royal Cornwall Hospital, Treliske, Truro, Cornwall TR1 3LJ UK.
authors.forename: Anmar K
authors.initials: AK
authors.lastname: Al-Shawi
keywords: Avascular necrosis; Capitate; Interposition arthroplasty; Pyrocarbon; Wrist