An occult fracture of the capitate bone
Zoakman, S.; Rhemrev, S.J.
Nederlands Tijdschrift Voor Geneeskunde 157(34): A6082
2013
ISSN/ISBN: 1876-8784 PMID: 23965240 Document Number: 666265
Evaluating patients with wrist injuries is diagnostically challenging. Physical examination alone is not sufficient for establishing a diagnosis and fractures of the wrist region are not always visible on x-rays. In this article, we present a case of a patient who had sustained trauma to the wrist and was taken care of at the emergency department. The mechanism of trauma and clinical findings strongly indicated a fracture of the scaphoid bone. No abnormality was visible on x-rays; the fracture was treated by casting nonetheless. On a CT scan performed later, there indeed appear to be a non-dislocated fracture of the capitate bone present. The diagnosis was confirmed by bone scintigraphy a few days later. The patient recovered without complications. Fractures of the capitate bone are serious carpal injuries that must be treated as aggressively as fractures of the scaphoid bone. Conventional radiological examinations cannot rule out a fracture of the wrist; if doubt persists, readily accessible imaging techniques (such as CT or MRI) should be conducted.