Investig Magn Reson Imaging.  2018 Jun;22(2):135-139. 10.13104/imri.2018.22.2.135.

Stress Fracture of the Capitate

• Cho HJ
• Hong KT
• Kang CH
• Ahn KS
• Kim Y
• Hwang ST

• KMID: 2415894
• DOI: http://doi.org/10.13104/imri.2018.22.2.135

Abstract

Most capitate fractures occur in association with additional carpal injuries, particularly scaphoid fractures. Isolated fractures of the capitate account for only 0.3% of carpal injuries, and stress fractures are one form of this fracture. We report the case of a 20-year-old male who had a stress fracture of the capitate after serving as an honor guard in the military. Conventional radiographs and computed tomography of the right wrist revealed a minimally displaced fracture line located at the midcarpal aspect of the right capitate. A magnetic resonance imaging scan demonstrates a subarticular capitate fracture with diffuse bone marrow edema, small osteophytes, and irregularity of the midcarpal articular cartilage. We also review the carpal kinematics which possibly caused the stress fracture. Although stress fractures of the capitate are rare, they should also be accounted for with patients who perform repetitive motions of the wrist to a considerable extent.

Keyword

Capitate bone; Carpal bones; Fractures, stress; Multidetector computed tomography; Magnetic resonance imaging

MeSH Terms

Biomechanical Phenomena
Bone Marrow
Capitate Bone
Carpal Bones
Cartilage, Articular
Edema
Fractures, Stress*
Humans
Magnetic Resonance Imaging
Male
Military Personnel
Multidetector Computed Tomography
Osteophyte
Wrist
Young Adult

Figure

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  Fig. 1 An illustration of the honor guard during the ceremony.

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  Fig. 2 Radiographs and CT of the right wrist of a 20-year-old honor guard suffering stress fracture of the capitate. (a, b) Anteroposterior and oblique radiographs demonstrate the fracture line located at the midcarpal aspect of the right capitate (arrows). (c, d) Coronal and sagittal multiplanar reconstruction bone window CT showed a minimally displaced curved fracture with surrounding sclerotic change (arrows).

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  Fig. 3 (a-c) Coronal proton-density-weighted fat-saturated, T1-weighted, and contrast agent-enhanced T1-weighted fat-saturated MR images of the right wrist show subarticular capitate fracture with diffuse bone marrow edema. An increased signal intensity with thickened volar capito-hamate ligament is also witnessed, which indicates a suspicious ligament injury (black arrows). (d) Sagittal T2-weighted fat-saturated MR image demonstrates small osteophytes in the capitate (red arrow) with irregularity of the midcarpal articular cartilage (white arrows), suggesting osteoarthritis.

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  Fig. 4 Kinematics of the wrist during flexion-extension and radioulnar deviation, with two axes of motion located within the head of the capitate.

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