Isolated Open Dislocation of the Capitate: A Case Report

CASE

We present a case of an isolated palmar, open dislocation of the capitate that occurred after a crush injury from an all-terrain vehicle rollover accident. The capitate was completely dislocated, rotated 90 degrees in the coronal plane with only soft-tissue attachments palmarly, and associated with a 4 cm open wound. A successful outcome was achieved via surgical reduction with percutaneous fixation. A follow-up at 44 months demonstrated good range of motion and no pain.

CONCLUSION

Capitate dislocations are extremely rare. Prompt identification and surgical reduction can lead to successful outcomes.

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.

[Fracture of os capitatum and os triquetrum in a child]

This is a case report of a seven-year-old boy with fractures of the capitate and triquetral bone. An X-ray revealed fractures of the capitate and triquetral bone, and a CT scan showed non-dislocated fractures suitable for conservative treatment. The patient was treated with a shin cast for four weeks and had full recovery. Fractures of both the capitate and triquetral bone in children under the age of ten have not previously been reported. Fractures of the carpal bones should be suspected and examined in children with relevant trauma and symptoms.

Association of lunate morphology, sex, and lunotriquetral interosseous ligament injury with radiologic measurement of the capitate-triquetrum joint

OBJECTIVE

Radiologic presentation of carpal instability at the radial side of the carpus, e.g. scapholunate diastasis following scapholunate interosseous ligament injury, has been studied extensively. By comparison, presentation at the ulnar-sided carpus has not. The purpose of this study was to assess the effects of lunate morphology, sex, and lunotriquetral interosseous ligament (LTIL) status on the radiologic measurement of the capitate-triquetrum joint (C-T distance). Further, we sought to evaluate the diagnostic accuracy of C-T distance for assessing LTIL injuries.

MATERIALS AND METHODS

We retrospectively identified 223 wrists with wrist radiographs and MR arthrograms with contrast injection. Data collected included sex, lunate morphology and LTIL status from MR arthrography, and C-T distance from radiography. The effects of lunate morphology, sex, and LTIL injury status on C-T distance were evaluated using generalized linear models. Diagnostic performance of C-T distance was assessed by the area under receiver-operator characteristic curve (AUROC).

RESULTS AND CONCLUSION

Lunate morphology, sex, and LTIL injury status all had significant effects on C-T distance; wrists with type II lunates, men, and wrists with LTIL injuries had greater C-T distances than wrists with type I lunates, women, and wrists without LTIL injuries, respectively (p < 0.01). The diagnostic value of the C-T distance for identifying patients with full-thickness LTIL tears was sufficient for women with type I (AUROC = 0.67) and type II lunates (0.60) and good for men with type I (0.72) and type II lunates (0.77). The demonstrated influence of LTIL status on C-T distance supports the use of C-T distance as a tool in assessing for full-thickness LTIL tears.

Capitate Fractures: A Review of 53 Patients

PURPOSE

To describe the demographics, diagnosis, management, and outcomes of capitate fractures in the adult and pediatric population treated in our institution.

METHODS

We performed a retrospective chart and radiographic review of 53 patients with capitate fractures treated in our institution between 2002 and 2015. Patients' demographic characteristics, mechanism of injury, management including surgery-related data, and outcomes, including complications, were recorded. A radiographic evaluation of the location and pattern of the fracture was performed.

RESULTS

Capitate fractures were prevalent in young males and older females. Fracture location was variable with 9 different locations; in addition 80% of patients had an associated fracture in the wrist or hand. The most common fracture pattern was the transscaphoid, transcapitate perilunate dislocation. Most diagnoses were made with the aid of advanced imaging. Within this series, there was only 1 case (4%) of fracture nonunion and there were no cases of avascular necrosis of the proximal pole in limited follow-up. Isolated capitate fractures were significantly more common in children. In addition, children had better functional outcomes than adults.

CONCLUSIONS

This series provides updated information on this rare injury. Nonunion of the capitate, which was previously described as the most common complication, was rare in this cohort.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.

[Isolated capitate fractures in the frontal plane]

Isolated fractures of the capitate in the frontal plane are both very rare and most of the time very discreet. There is a great risk to miss such fractures with potential longterm consequences. The following report of two independent patients highlights the importance of computed tomography in order to verify fractures and initiate adequate treatment.

[An occult fracture of the capitate bone]

BACKGROUND

Evaluating patients with wrist injuries is diagnostically challenging. Physical examination alone is not sufficient for establishing a diagnosis and fractures of the wrist region are not always visible on x-rays.

CASE DESCRIPTION

In this article, we present a case of a patient who had sustained trauma to the wrist and was taken care of at the emergency department. The mechanism of trauma and clinical findings strongly indicated a fracture of the scaphoid bone. No abnormality was visible on x-rays; the fracture was treated by casting nonetheless. On a CT scan performed later, there indeed appear to be a non-dislocated fracture of the capitate bone present. The diagnosis was confirmed by bone scintigraphy a few days later. The patient recovered without complications.

CONCLUSION

Fractures of the capitate bone are serious carpal injuries that must be treated as aggressively as fractures of the scaphoid bone. Conventional radiological examinations cannot rule out a fracture of the wrist; if doubt persists, readily accessible imaging techniques (such as CT or MRI) should be conducted.

[Delayed healing in long bone fracture: radiologic course and treatment]

Isolated long bone fractures are unusual and may be missed in the initial X-rays, especially when they are minimally displaced. The delayed treatment of these fractures may cause various complications, such as delayed bone healing or seudoarthrosis, which are difficult to manage. Our clinical case shows delayed healing in a long bone fracture and how the radiologic course may assist in the therapeutic management of this complication.

Segmental radius and ulna fractures with scaphocapitate fractures and bilateral multiple epiphyseal fractures

Segmental forearm fractures are rare in children, and management is controversial. Epiphyseal injuries further complicate matters. We report the case of a 15-year-old boy who had segmental radius and ulna fractures with a coronal split of a metaphyseal fragment, along with bilateral epiphyseal fractures of the distal radius and ulna as well as ipsilateral scaphocapitate fractures with perilunate dislocation. There was also a contralateral fracture through the radial neck. The patient underwent immediate internal fixation of the forearm fractures and delayed fixation of the scaphocapitate fractures. Results at 12 months showed excellent functional outcome.

Delayed post-traumatic midcarpal dislocation

We report a case of delayed post-traumatic volar midcarpal dislocation in a 39 year-old woman. The dislocation was a gradual process starting from the time of injury. Initial X-rays showed a normal midcarpal joint. By 6 weeks, lunocapitate subluxation was apparent radiologically and by the 18 week X-ray, midcarpal dislocation had occurred. This type of wrist injury has not been previously reported. Because of advanced degenerative changes in the lunocapitate joint, a partial wrist fusion was performed with a successful outcome.

[Wrist perilunate dislocation]

Carpal perilunate dislocations are rare and underdiagnosed because of an ignorance of the pathology and an inappropriate incidence of radiography. The carpus is composed of two rows of bones and 33 ligaments. These ligaments are fundamental for wrist stability. Typically, the injury occurs in young male adults exposed to high-energy trauma with a wrist in hyperextension. The diagnosis is easy with a physical examen and standard postero-anterior and lateral radiographs. The Witvoët and Allieu classification of the perilunate dislocations is the most used. This classification is composed of three grades. The treatment is usually surgical and has to be realised in a short delay to minimize the important complications.

Scaphoid non-union after simultaneous fractures of the scaphoid and the capitate in a child: a case report

A nine-year-old boy fell on his outstretched hand and was diagnosed with simultaneous fractures of the scaphoid and the capitate. The patient was treated conservatively with a cast for two months. Fracture of the capitate healed, however, fracture of the scaphoid resulted in non-union. We treated scaphoid non-union with an iliac bone graft and internal fixation. Three years after surgery, the patient had neither complaints nor complications and union of the scaphoid was confirmed on the radiographs.

Fenton syndrome in an adolescent

Scapho-capitate fracture (Fenton syndrome) is a rare lesion and is even less well-documented in adolescents. The most frequent mechanism is possible forced extension and hyperextension of the wrist. We report a case of 15 years old boy with hyperextension injury to the wrist. The true diagnosis was made 2 weeks later. Treatment involved open reduction and internal fixation with K-wires and Herbert screws. It went on to heal well and at 6 months follow-up, there was no infection or avascular necrosis and wrist function was good.

Die avaskuläre Kapitatumnekrose bei Sportlern

The possibility of osteonecrosis of the carpal bones should always be considered when athletes present with pain of unknown origin in the hand and wrist, in particular, if they are participating in sports such as gymnastics or weight-lifting that involve extreme loading of the wrist with axial compression and microtrauma. This sort of extreme loading of the wrist combined with a constitutionally "weak" blood supply to the individual carpal bones may lead to the formation of osteo-necrotic zones. A treatment method that can produce excellent results, depending on the pathomorphology, is available in the form of vascularized bone grafting.

Scaphoid and capitate fracture with concurrent scapholunate dissociation

Combined fracture of the scaphoid and capitate bones with concurrent scapholunate dissociation, but without severe dislocation, is a rare lesion which results in significant carpal instability and requires operative treatment. We report a case of this unusual injury and its functional result after 20 months.

Simultaneous fractures of the capitate and hamate in the coronal plane: case report

Fractures of the carpal bones in the coronal plane are encountered rarely and their diagnosis usually is delayed. Coronal hamate fractures are relatively well described but a coronal capitate fracture occurring simultaneously with a coronal hamate fracture is extremely rare. We describe such an injury addressed with fixation of the hamate alone.

Trans-scaphoid, Transcapitate, Transhamate Injury: A Case Report

Traumatic axial dislocation of the carpus in a 20-year-old man is described. This injury was accompanied by a crushing injury to the hand. The disruption pattern was different from those of previously reported cases. Despite the restoration of painless wrist motion postoperatively, grip strength remained below normal. Early accurate reduction, fixation, and range of motion exercise are the treatments of choice in such complex injuries.