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Capitate Fractures: A Review of 53 Patients
Assaf Kadar, MD1,2; Mohamed Morsy, MD1; Yoo Joon Sur, MD, PhD1; Osman Akdag, MD1; Steven L. Moran, MD1
1Mayo Clinic, Rochester, MN, 2Tel Aviv Sourasky Medical Center Orthopaedic Division, Tel Aviv, Israel
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 2002-2015. Patients' demographics, mechanism of injury, management including surgical related data and outcomes including complications were recorded. A radiographic evaluation of the location and pattern of the fracture was performed and the false negative rates of the different imaging modalities was assessed.
Results: Capitate fractures followed a bimodel age distribution of younger males with high energy trauma and older females with low energy trauma. Fracture location was variable with 9 different locations; additionally 80% of patients had an associated fracture in the wrist or hand. The most common pattern was that of trans-scaphoid, transcapitate perilunate greater arc injury, and had a noticeable continuum of severity and fracture displacement with the most severe injury being the scapho-capitate syndrome. Clinical signs were nonspecific for this injury and plain radiographs had a low sensitivity of 21%. Most diagnoses were made with advanced imaging. Only one case (4%) of fracture nonunion was recorded in our cohort and no cases of proximal pole avascular necrosis. Children with capitate fractures had a significantly greater chance for an isolated fracture (50%), and had better functional outcomes than the adult population.
Conclusion: Our study provides an updated knowledge base on this rare injury. Nonunion and avascular necrosis of the capitate, which were previously described as the most common complications, were rare in our cohort; this may be due to early diagnosis and treatment . Surgeons should consider advance imaging whenever this injury is suspected and not rely on plain radiographs. Figure 1: Location of fracture in the capitate bone
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