Causes and risk factors
Like any other fracture, the major cause of capitate fracture is road accident or vehicular injury. Fall onto the wrist causing severe pressure or force on the bone can lead to its breakage. Dorsal blow or crush injuries particularly result in fracture of this bone. Indirect trauma can also lead to capitate fracture. Often capitate fracture is associated with other carpal bone fractures. Excessive dorsal or palmar flexion due to load can lead to its dislocation. It can also be associated with muscular or ligamentous injuries of the wrist. Microtrauma resulting due to repeated force or trauma is another contributing factor seen. This is particularly seen in various sports activities like tennis, baseball, golf, and hockey.
Clinical presentation:
Capitate fractures are classified into two types – scaphoid capitates syndrome and isolated capitate fracture. Isolated capitate fracture is one where the capitate alone is involved, while in scaphoid capitates fracture, scaphoid wrist fracture along with proximal capitates fracture is seen. Commonly, the neck of the capitate is more commonly affected in capitates fracture. Pain is a prominent feature seen. Along with this, swelling and bruising are the other complaints. Pain is especially seen at the middle of the palm. Swelling occurs. Weak grip is a common complaint. Movement of the palm can cause pain. On examination, tenderness is present.
Investigations:
Considering the symptoms, a local examination is carried out by the orthopedic doctor. There is often a history of injury. X-ray of the carpal bones in most of the cases can be negative. Repeated x-rays or investigations like CT scan can be done.
Treatment:
Rest, elevation of the arm, and application of ice packs are the essential steps that could be implemented. Analgesic or nonsteroidal anti-inflammatory drugs are advised by the orthopedic doctor for relief of the pain. Short arm cast is applied for immobilization for 6-8 weeks. Excision is done to remove the fragments. Open reduction is done for internal fixation with use of K-wires and screws. As recovery starts, certain physiotherapy exercises are advised under the guidelines of a trained physiotherapist.
Other Modes of treatment:
Certain other modes of treatment can also be helpful in coping up with the symptoms. Taking into consideration the symptoms in a holistic way, homoeopathy can offer a good aid for the relief of the symptoms. The Ayurvedic system of medicine which uses herbs and synthetic derivates can also be beneficial in combating the complaints arising from capitate fracture. Certain yoga exercises can also be helpful in strengthening the muscles.
