Scaphocapitate fracture syndrome in a child

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Abstract

BACKGROUND: Scaphocapitate fracture syndrome involves transverse fracture of the scaphoid and capitate, with rotation of 90° or 180° of the proximal fragment of the capitate, commonly associated with other carpal lesions. It is a rare wrist injury, usually occurs in young men and is exceptional in children. The exact mechanism remains controversial. The injury is often misdiagnosed as a simple scaphoid fracture and there has been a controversy about the treatment of the capitate fracture in this syndrome.

CLINICAL CASE: The authors report a rare case of a scaphocapitate syndrome in a 15-year-old boy. Early open reduction of both fractures was performed. It was obtained a good mobility, with a normal grip strength and the radiographs showed union of both bones without avascular necrosis.

DISCUSSION: Most authors agree that regardless of the radiographic appearance of the injury, open reduction and internal fixation is the treatment of choice. The dorsal approach is the most used. The capitate fragment is usually devoid of any soft tissues and is reduced relatively easy with manual pressure, by applying traction to the hand. Reduction and fixation of the capitate must precede that of the scaphoid. K-wires or headless screws may be placed from the proximal to the distal side for the fixation of the scaphoid and capitate. The evolution is marked by the risk of occurrence of head capitate avascular necrosis

CONCLUSIONS: This case report illustrates that the scaphocapitate syndrome can occur in children and is important an early diagnosis to initiate timely treatment. Our patient was successfully treated with open reduction and fixation using K-wires.

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About the authors

Patrícia Wircker

Hospital de Cascais

Email: patriciawircker@gmail.com
ORCID iD: 0000-0002-2731-5868

Trauma and Orthopedic Surgery Resident

Portugal, Av. Brigadeiro Victor Novais Gonçalves, 2755-009 Alcabideche, Lisbon

Teresa Alves da Silva

Hospital de Cascais

Email: alvesdasilva.t@gmail.com

Trauma and Orthopedic Surgeon

Portugal, Av. Brigadeiro Victor Novais Gonçalves, 2755-009 Alcabideche, Lisbon

Rafael Dias

Hospital de Cascais

Author for correspondence.
Email: rafaelrmdias@gmail.com

Trauma and Orthopedic Surgery Resident

Portugal, Av. Brigadeiro Victor Novais Gonçalves, 2755-009 Alcabideche, Lisbon

References

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  8. Kim YS, Lee HM, Kim JP. The scaphocapitate fracture syndrome: a case report and literature analysis. Eur J Orthop Surg Traumatol. 2013;23(S2):207–212. doi: 10.1007/s00590-013-1182-5
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Supplementary files

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1. Fig. 1. Fracture of the scaphoid with a fragment of the capitate bone on the radiograph of the left hand (immediately after the injury)

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2. Fig. 2. CT scan with fracture of scaphoid associated with 180° rotation of the proximal pole capitate fragment: a, anterior plane; b, lateral plane; c, tridimensional plan view

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3. Fig. 3. Fragment of the capitate bone, rotating 180 ° (longitudinal section on the back of the wrist)

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4. Fig. 4. Reposition of the capitate bone fragment

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5. Fig. 5. Capitate fragment indirectly fixated by stabilizing the carpus with K-wires. The scaphoid fracture was fixed with a compression screw: a, intraoperative photography; b, fluoroscopy image

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6. Fig. 6. Immobilization of the hand with a shortened plaster cast over the shoulder

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7. Fig. 7. Union of both bones: a, anterior X-ray view; b, lateral view

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Copyright (c) 2021 Wircker P., Alves da Silva T., Dias R.

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