Mateusz Gładysz FESSH prep

FESSH prep Wrist trauma Carpal bone fracture and scaphocapitate syndrome

Capitate fractures

Last reviewed v1.0

FESSH-024Wrist trauma●●● advanced

Regarding capitate fractures, which of the following statements are true?

  1. 1.Capitate fractures are the most common type of carpal bone fracture.

  2. 2.Isolated capitate fractures are more common than capitate fractures occurring in association with other carpal injuries.

  3. 3.In the Mayo Clinic series of 53 patients with capitate fractures, one nonunion and no proximal-pole avascular necrosis were reported during limited follow-up.

  4. 4.Non-displaced capitate fractures can typically be managed conservatively with short-arm cast immobilisation.

  5. 5.The scaphocapitate (Fenton) syndrome consists of concurrent fractures of the scaphoid and capitate with 90° to 180° rotation of the proximal capitate fragment in the sagittal plane.

FESSH marking: +1 per correct statement, 0 for blank, −1 for incorrect. Click the same TRUE/FALSE button twice to clear it.

Question ID
FESSH-024
First published
Last reviewed
Version
v1.0
Answer key and explanations — open after answering

  1. 1. Capitate fractures are the most common type of carpal bone fracture.

    False

    Capitate fractures account for approximately 1–2% of all carpal fractures. The scaphoid is the most commonly fractured carpal bone (approximately 60–70% of carpal fractures in most series), and the triquetrum is the second most common.

    • Suh N, Ek ET, Wolfe SW. Carpal fractures. J Hand Surg Am. 2014;39(4):785-791. PMID 24679911
    • Kadar A, Morsy M, Sur YJ, Akdag O, Moran SL. Capitate fractures: a review of 53 patients. J Hand Surg Am. 2016;41(10):e359-e366. PMID 27524693

  2. 2. Isolated capitate fractures are more common than capitate fractures occurring in association with other carpal injuries.

    False

    In the Mayo Clinic series of 53 capitate fractures reported by Kadar and colleagues, 80% of patients had an associated wrist or hand fracture, most commonly as part of a transscaphoid transcapitate perilunate dislocation. Isolated capitate fracture is the minority pattern.

    • Kadar A, Morsy M, Sur YJ, Akdag O, Moran SL. Capitate fractures: a review of 53 patients. J Hand Surg Am. 2016;41(10):e359-e366. PMID 27524693
    • Bain GI, McLean JM, Turner PC, Sood A, Pourgiezis N. Translunate fracture with associated perilunate injury: 3 case reports with introduction of the translunate arc concept. J Hand Surg Am. 2008;33(10):1770-1776. PMID 19084176

  3. 3. In the Mayo Clinic series of 53 patients with capitate fractures, one nonunion and no proximal-pole avascular necrosis were reported during limited follow-up.

    True

    Kadar and colleagues reviewed 53 patients with capitate fractures and reported one nonunion and no proximal-pole avascular necrosis during limited follow-up. These observations do not establish a zero long-term risk of avascular necrosis. In a separate micro-computed tomography study, direct proximal-pole vessels entered through the volar capitate ligaments in seven of ten cadaveric specimens, a possible anatomical explanation for preservation of proximal-pole vascularity after some fractures.

    • Kadar A, Morsy M, Sur YJ, Akdag O, Moran SL. Capitate fractures: a review of 53 patients. J Hand Surg Am. 2016;41(10):e359-e366. PMID 27524693
    • Kadar A, Morsy M, Sur YJ, 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(2):78-86. PMID 28160904

  4. 4. Non-displaced capitate fractures can typically be managed conservatively with short-arm cast immobilisation.

    True

    Isolated, non-displaced capitate fractures heal reliably with short-arm cast immobilisation for approximately 6–8 weeks. Displaced fractures, fractures associated with perilunate injury, and rotated proximal-pole fragments require open reduction and internal fixation.

    • Suh N, Ek ET, Wolfe SW. Carpal fractures. J Hand Surg Am. 2014;39(4):785-791. PMID 24679911
    • Davis TRC. Green's Operative Hand Surgery. 8th. Philadelphia, PA: Elsevier; 2022. ISBN 978-0-323-69793-4

  5. 5. The scaphocapitate (Fenton) syndrome consists of concurrent fractures of the scaphoid and capitate with 90° to 180° rotation of the proximal capitate fragment in the sagittal plane.

    True

    Scaphocapitate syndrome — first described by Fenton in 1956 as the naviculo-capitate fracture syndrome — is a rare variant of greater-arc perilunate injury. The proximal capitate fragment rotates 90° or 180°, often facing the distal capitate, and prompt open reduction with internal fixation is required to prevent nonunion and avascular necrosis.

    • Fenton RL. The naviculo-capitate fracture syndrome. J Bone Joint Surg Am. 1956;38-A(3):681-684. PMID 13319423
    • Apergis E, Darmanis S, Kastanis G, Papanikolaou A. Does the term scaphocapitate syndrome need to be revised? A report of 6 cases. J Hand Surg Br. 2001;26(5):441-445. PMID 11560426