The Common Vein Copyright 2011
Definition
Fractures of the capitate bone of the hand are usually caused by direct trauma, but sometimes caused by gunshot injury. It is commonly injured with traumatic injury of the greater arc (trapezium, capitate, hamate and triquetrum). These injures can be transscaphoid, transcapitate perilunate fracture-dislocation, or the naviculocapitate syndrome. The naviculocapitate syndrome include fractures of the capitate and scaphoid without dislocation.
The fracture may be complicated in the acute phase by neurovascular injury, or in the subacute or chronic phases by nonunion, malunion, infection, osteonecrosis, or osteoarthritis.
The diagnosis of this injury is usually made by a combination of physical examination and x-ray imaging.
Imaging includes the use of plain x-rays, and if indicated CT-scan, or MRI.
Treatment of capitate fractures require reduction to reduce the risk of osteonecrosis. A closed reduction is usually attempted. If the fracture cannot reduce, then an open reduction internal fixation with screws or Kirschner wires should be performed.
The AP examination of the normal wrist shows the capitate in the second carpal row
Courtesy Ashley Davidoff MD 45738c01
The coronal reconstruction of the wrist shows the normal capitate (c)
Courtesy Ashley Davidoff MD Copyright 2011 46616b01
The lateral reconstruction of the wrist shows the normal capitate (c)
Courtesy Ashley Davidoff MD Copyright 2011 46615b01References
Davis MF, Davis PF, Ross DS. Expert Guide to Sports Medicine. ACP Series, 2005.
Elstrom J, Virkus W, Pankovich (eds), Handbook of Fractures (3rd edition), McGraw Hill, New York, NY, 2006.
Koval K, Zuckerman J (eds), Handbook of Fractures (3rd edition), Lippincott Williams & Wilkins, Philadelphia, PA, 2006.
Lieberman J (ed), AAOS Comprehensive Orthopaedic Review, American Academy of Orthopaedic Surgeons, 2008.
Moore K, Dalley A (eds), Clinically Oriented Anatomy (5th edition), Lippincott Williams & Wilkins, Philadelphia, PA, 2006.