Isolated capitate fracture

Case contributed by Dr Alborz Jahangiri

Presentation

Right hand caught in the door 6 months ago. Wrist pain, swelling and decreased ROM since the injury and symptoms not improving. came for imaging studies for the first time after 6 months.

Patient Data

Age: 20
Gender: Female
X-ray

There is a 3mm bony fragment on the dorsal aspect of the capitate - appearances suggest an avulsion fracture. There is sclerosis of the mid / distal capitate. There is minimal associated subcutaneous soft tissue swelling. The articular surface appears intact. There is no separation of the ulnar styloid process. The adjacent joint alignment appears normal. 

 

CT

There is a transverse fracture of the middle - distal third of the capitate bone. The fracture line is sclerotic in keeping with longstanding injury. No callus formation is identified. There are small bony fragments on the dorsal and volar aspect of the capitate bone - the largest measures 4 x 2mm on the dorsum and corresponds to the bony fragment noted on the x-ray.

There is at least one 2mm intra articular loose body / bony fragment in the capitate lunate joint and a bony fragment in the capitate trapezoid joint. The bone density of the capitate is otherwise within normal limits with no signs of avascular necrosis. 

Case Discussion

There are appearances of non-union of the capitate bone fracture with intra-articular loose bodies.

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Case information

rID: 45809
Case created: 9th Jun 2016
Last edited: 14th Apr 2017
Inclusion in quiz mode: Included

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