Capitate fracture

Background

• Isolated capitate fractures are rare (scaphoid is most common associated fracture)
• Occurs via forceful dorsiflexion of hand (FOOSH injury) with impact on radial side
• Proximal fracture fragment at risk for avascular necrosis

Clinical Features

• Diffuse swelling and tenderness over capitate (just proximal to 3rd metacarpal)

Differential Diagnosis

Carpal fractures

AP view

• Scaphoid fracture
• Lunate fracture
• Triquetrum fracture
• Pisiform fracture
• Trapezium fracture
• Trapezoid fracture
• Capitate fracture
• Hamate fracture

Evaluation

• Hand x-ray
• Often overlooked due to accompanying scaphoid fracture or lunate/perilunate dislocation

Capitate fracture

Management

General Fracture Management

• Acute pain management
• Open fractures require immediate IV antibiotics and urgent surgical washout
• Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention
• Consider risk for compartment syndrome

Specific Management

• Isolated capitate fracture requires forearm volar splint immobilization and early ortho referral
• Capitate fracture associated with scaphoid fracture or dislocations requires surgical treatment

Disposition

• Generally may be dishcarged

See Also

• Carpal fractures