Isolated Fractures of the Capitate: Use of Nuclear Medicine as an Aid to Diagnosis

Abstract

Fractures of the capitate are considered to be uncommon injuries of the wrist, however, delay in diagnosis may result in prolonged disability and avascular necrosis. Two cases are reported in which an isolated fracture of the capitate was diagnosed with a 99mTc-MDP nuclear medicine bone scan and confirmed with CT scan or repeated conventional x-rays. These two cases illustrate that an isolated fracture of the capitate should be considered in an individual presenting with persistent wrist pain of traumatic origin, even when conventional x-ray views are negative. The nuclear medicine bone scan can be a useful investigative tool and serve to guide further radiological investigations.

An unusual variant of fracture through the capitate bone--a case report

“…In our patient, two plain radiographic examinations showed no fracture, which is common in cases of an isolated capitate fracture (Albertsen et al 1999, Calandruccio andDuncan 1999). However, MRI, CT, and bone scans are useful for diagnosing isolated wrist fractures (Hopkins and Ammann 1990, Albertsen et al 1999, Bretlau et al 1999, Calandruccio and Duncan 1999, Rayan 1994, Schick et al 1999. Albertsen et al (1999) described a similar fracture, but that fracture was seen even on the plain radiograph.…”

Isolated Displaced Capitate Fracture: A Case Report

“…Isolated capitate fracture may be misdiagnosed because of the lack of clinical symptoms and its ambiguous radiographs. Bone scan (10), CT scan (11), and MRI (9) have been recommended for these occult fractures. Johnson (12) reported that the lunate's posterior margin causes 'beheading' of the capitate, but with significant traumas with wrist hyperextension (1,8).…”

Isolated Capitate Fracture with Dorsal Dislocation of Proximal Pole: A Case Report

“…Such injuries may be under-diagnosed due to paucity of clinical symptoms and radiologically occult geometry. Bone scan [9], CT scan [2] and MRI [4] have been advocated for such occult fractures.…”