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Management of Isolated Capitate Nonunion: A Case Series and Literature Review
09 January 2018
09 April 2018
23 May 2018 (online)
Background Isolated capitate nonunion is rare. No consensus on the appropriate treatment for this condition exists.
Case Description We reported two cases of capitate fracture nonunion presenting several months after untreated high-impact wrist trauma. Treatment was delayed as both patients' nonunions were missed on conventional radiographs. Both were ultimately diagnosed with advanced imaging and successfully treated with internal fixation and autogenous bone grafting. The relevant literature pertaining to capitate nonunion was reviewed.
Literature Review Immobilization and internal fixation with bone grafting for capitate nonunion have been described in the literature. Loss of vascular supply and progression to avascular necrosis is a concern after capitate nonunion.
Clinical Relevance We present two cases and review the literature on the diagnosis and treatment of this rare injury to guide management. Internal fixation with autogenous bone grafting could play a role in management for this rare condition.
This investigation was performed at Hospital for Special Surgery and Stanford University Medical Center.
- 1 Gümüştaş SA, Tosun HB, Ağır I, Uludağ A. Nonunion of capitate due to late diagnosis in a teenager. Am J Case Rep 2014; 15: 139-142
- 2 Freeland AE, Pesut TA. Oblique capitate fracture of the wrist. Orthopedics 2004; 27 (03) 287-290
- 3 Albertsen J, Mencke S, Christensen L, Teisen H, Hjarbäk J. Isolated capitate fracture diagnosed by computed tomography. Case report. Handchir Mikrochir Plast Chir 1999; 31 (02) 79-81
- 4 Rand JA, Linscheid RL, Dobyns JH. Capitate fractures: a long-term follow-up. Clin Orthop Relat Res 1982; (165) 209-216
- 5 Yoshihara M, Sakai A, Toba N, Okimoto N, Shimokobe T, Nakamura T. Nonunion of the isolated capitate waist fracture. J Orthop Sci 2002; 7 (05) 578-580
- 6 Gehrmann SV, Wild M, Windolf J, Hakimi MY. Isolated fractures of the capitate: treatment of delayed union [in German]. Handchir Mikrochir Plast Chir 2009; 41 (03) 175-178
- 7 De Schrijver F, De Smet L. Isolated fracture of the capitate: the value of MRI in diagnosis and follow up. Acta Orthop Belg 2002; 68 (03) 310-315
- 8 Cooney AD, Stuart PR. Symptomatic nonunion of an isolated capitate fracture in an adolescent. J Hand Surg Eur Vol 2013; 38 (05) 565-567
- 9 Geissler WB, Slade SF. Fractures of the carpal bones. In: Wolfe SW, Hotchkiss RN, Peterson WC, Kozin SH. , eds. Green's Operative Hand Surgery. 6th ed. Philadelphia, PA: Elsevier; 2010: 639-707
- 10 Vander Grend R, Dell PC, Glowczewskie F, Leslie B, Ruby LK. Intraosseous blood supply of the capitate and its correlation with aseptic necrosis. J Hand Surg Am 1984; 9 (05) 677-683
- 11 Kadar A, Morsy M, Sur Y-J, Laungani AT, Akdag O, Moran SL. The vascular anatomy of the capitate: new discoveries using micro-computed tomography imaging. J Hand Surg Am 2017; 42 (02) 78-86
- 12 Rancy SK, Swanstrom MM, DiCarlo EF, Sneag DB, Lee SK, Wolfe SW. ; Scaphoid Nonunion Consortium. Success of scaphoid nonunion surgery is independent of proximal pole vascularity. J Hand Surg Eur Vol 2018; 43 (01) 32-40