29 January 2024 : Case report
[In Press] Capitate Proximal Fragment Migration Compressing the Median Nerve in Scaphocapitate Fracture: A Case Report
Challenging differential diagnosis, Management of emergency care, Rare diseaseVasileios Giannatos 1ABCDEF, Theodoros Stavropoulos1BCF, Charalampos Charalampous-Kefalas 1BCD, Panagiotis Antzoulas 1BCE, Andreas Panagopoulos 1ADE, Zinon Kokkalis 1ABDEF
Am J Case Rep In Press; DOI: 10.12659/AJCR.942867
Available online: 2024-01-29, In Press, Corrected Proof
Publication in the "In-Press" formula aims at speeding up the public availability of the pending manuscript while waiting for the final publication. The assigned DOI number is active and citable. The availability of the article in the Medline, PubMed and PMC databases as well as Web of Science will be obtained after the final publication according to the journal schedule
Scaphocapitate syndrome is a rare clinical entity consisting of a combined scaphoid and capitate fracture along with a 90- or 180-degrees rotation of the proximal capitate fragment. The syndrome is scarcely described in the literature, with proximal migration of the capitate fragment being reported only by Mudgal et al in 1995. Concurrent compression of the median nerve is a highly unfortunate event, suggesting a unique case presented here.
We present a unique case of scaphocapitate fracture-dislocation in a 25-year-old man with volar dislocation of the capitate’s fragment deep to the median nerve. X-rays and CT scan were performed and the patient was treated few hours after the injury by a hand specialist, in order to prevent median neuropathy and avascular necrosis of the fragment. Open reduction and internal fixation utilizing a Herbert screw for the scaphoid fracture and 3 additional K-wires was performed. Immediately post-operatively, the acute neurological symptoms had subsided and good reduction was acquired radiologically. One year post-operatively the patient had regained good hand and wrist functionality, with no extension or flexion ROM deficits.
Immediate intervention in a specialized center with reduction and fixation utilizing a Herbert screw and K-wires showed favorable 1-year results in our case of scaphocapitate syndrome. The impending complications of median neuropathy and capitate avascular necrosis were avoided despite the high-risk injury pattern.
Keywords: Wrist; Wrist Injuries; Traumatology; Scaphoid Bone; Capitate Bone; Median Nerve
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