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Capitate Fracture
From WikiSM
Other Names
- Scaphocapitate syndrome
Background
- Capitate fractures represent 1-2% of carpal fractures
- 4th most common carpal fracture
Pathophysiology
- Mechanism of injury is debated, proposed mechanisms include
- Direct axial load down the third metacarpal base from fall onto extended wrist in ulnar deviation
- Transverse body fractures are most common
- Frequently co-occur with[1]
- Scaphocapitate syndrome
- Rare presentation where proximal capitate fragment rotates 180° in the sagittal plane [2]
Risk Factors
- Unknown
Differential Diagnosis
Carpal Bone Fractures
- Scaphoid Fracture
- Lunate Fracture
- Triquetrum Fracture
- Pisiform Fracture
- Trapezium Fracture
- Trapezoid Fracture
- Capitate Fracture
- Hamate Fracture
Differential Diagnosis Wrist Pain
- Fractures
- Dislocations
- Wrist Dislocation (Radiocarpal and/or Ulnocarpal)
- Carpometacarpal Joint Dislocation
- Distal Radioulnar Joint Dislocation
- Lunate Dislocation
- Perilunate Dislocation
- Instability & Degenerative
- Tendinopathies & Ligaments
- Neuropathies
- Pediatric Considerations
- Distal Radial Epiphysitis (Gymnast's Wrist)
- Torus Fracture
- Arthropathies
- Cartilage
- Vascular
- Other
Clinical Features
- General: Physical Exam Wrist
- Patients tend to present with a painful, swollen wrist
Evaluation
Radiographs
- Standard Radiographs Wrist
- 3 view initial imaging of choice
CT, MRI
- Consider to further evaluate fracture pattern, surgical planning and soft tissue injuries
Classification
- Transverse pole
- Transverse body
- Verticofrontal
- Parasagittal fractures
Management
Nonoperative
- Surgical management generally preferred
- Recommend surgical consult
- Immobilize in Short Arm Cast or Sugar Tong Splint
Operative
- Indications
- Capitate head fractures due to high risk of nonunion
- Capitate neck fractures
- Nondisplaced fractures
Return to Play
- Physician discretion depending on surgical management
- Minimum 4-6 weeks
Complications
- Nonunion
- Malunion
- Carpometacarpal Arthritis
- Avascular necrosis
See Also
- Internal
- External
- Sports Medicine Review Wrist Pain: https://www.sportsmedreview.com/by-joint/wrist/
