An isolated capitate fracture in a 9-year-old boy

Delayed union of a pediatric lunate fracture in the United Kingdom: a case report and a review of current concepts of non-scaphoid pediatric carpal fractures

Pediatric carpal fractures are rare and often difficult to detect. This paper reviews the current literature on pediatric non-scaphoid carpal fractures, with a case report of a lunate fracture associated with a distal radius and ulnar styloid fracture, managed nonoperatively in a 12-year-old boy. There is lack of consensus regarding the management of these fractures due to the low number of reported cases. A frequent lack of long-term follow-up limits our understanding of the outcomes, but good outcomes have been reported for both nonoperative and operative management. This case report brings attention to the current time period for the definition of delayed union in pediatric carpal fractures, and emphasizes the need for prolonged follow-up for the detection of delayed complications leading to functional impairment.

Nonunion of the Capitate due to Delayed Diagnosis of an Isolated Fracture: A Case Report

CASE

A 14-year-old girl was diagnosed with nonunion of an isolated capitate fracture 5 months after she first presented to the emergency department. The fracture of the capitate was treated by cancellous proximal bone graft and screw fixation. This current case provides details of the surgical fixation method and long-term functional outcome after nonunion of an isolated capitate fracture after a follow-up of 18 months following fixation.

CONCLUSIONS

Persisting localized tenderness over the capitate should be an indication to perform an additional computed tomography or magnetic resonance imaging scan. Nonunion of isolated capitate fractures can be treated by means of open reduction and internal fixation, with autologous bone grafting.

[Carpal injuries in children]

Carpal injuries in children are uncommon. Radiographic diagnosis can be difficult because of late ossification of carpal bones. Scaphoid fracture occurs in 3% of hand and wrist fractures. Fractures in the distal third or at the waist are the most frequent fracture sites. In case of clinical and X-rays presumption, CT-scan and MRI often diagnose scaphoid fractures. Orthopaedic treatment with closed cast for 8 weeks, or more for adolescents, gives a high rate of union in non-displaced or minimally-displaced fractures. Non-union is the most frequent complication. Closed cast can be the treatment of non-union in absence of humpback or DISI deformity. Other carpal bone fractures or ligament injuries of the wrist in children are uncommon and CT-scan, MRI or arthroscopy can be useful in case of clinical suspicion.

Long-term follow-up of a malunited, isolated fracture of the capitate in a 6-year-old boy

A 6-year-old boy with an isolated fracture of the capitate was presented. First radiograghs at our clinic revealed an oblique fracture with a displacement of 5 mm on the lateral view, which we successfully treated with immobilization. When complete union was recognized in the radiographs, the capitate had a deformity consisting of a large prominence on the palmar aspect. During follow-up, the capitate showed marked remodeling and at four and a half years after injury it had regained an almost normal shape. Eleven years after injury, there were no radiographic changes such as malalignment or arthrosis in the carpal bones.

Trans-carpal injuries associated with distal radial fractures in children: a series of three cases

Isolated trans-carpal injuries in children are rare. This paper presents three cases of trans-carpal injury associated with an ipsilateral distal radial fracture. Two cases involved simultaneous fractures of the scaphoid and the capitate. The third case involved the scaphoid and the triquetrum. The full extent of these injuries was not recognized on the initial X-rays. If a child presents with a displaced fracture of one carpal bone it may not be an isolated injury.