Fracture dislocation of the capitate following major trauma: A case report and literature review

Abstract

Introduction: Capitate fractures are rare and account for just 1.3% of all carpal fractures. A volarly displaced fragment is a rare complication and has only previously been reported in two cases. Aim: To highlight the increasing incidence of severe wrist trauma with more patients surviving major trauma and present our management of such cases with complex wrist injury. Case: A 38-year-old male presented to our department with major trauma following a fall from 10 meters, sustaining significant head and chest injuries along with bilateral upper extremity injuries. Following initial resuscitation, investigations revealed extensive craniofacial injuries with an open skull fracture, and also a left-sided pneumothorax. After treatment of the life-threatening injuries, imaging revealed a grossly displaced capitate fracture with a volarly displaced fragment in the soft tissues of the forearm. This was associated with a scaphoid fracture. Surgical intervention was carried out to retrieve the displaced fragment and reduce and hold the position of the carpus. Result: Three months following the injury, the patient was continuing to demonstrate improvements in wrist function and exhibited reduced pain levels. Conclusion: More patients are surviving major trauma events and have multiple complex limb injuries. We underscore the importance of having a high index of suspicion for complex injuries in high energy trauma and also the importance of appropriate and prompt management of such cases at specialized institutions.