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Case Reports
. 2021 Dec 23;12(2):143-146.
doi: 10.1055/s-0041-1740402. eCollection 2023 Apr.

Neglected Scaphocapitate Syndrome

Assaf Kadar  1 , Sorin D Iordache  1
Affiliations
Case Reports

Neglected Scaphocapitate Syndrome

Assaf Kadar et al. J Wrist Surg. .

Abstract

Background Scaphocapitate syndrome is a rare injury where the proximal pole of the capitate rotates 90 to 180 degrees. The proximal pole of the capitate, thought to receive its vascular supply retrograde, is rendered avascular in such cases. However, recent evidence of low rates of avascular necrosis in displaced capitate fractures, and new vascular studies of the capitate, challenge this paradigm. Case Description We report a case of a missed and neglected scaphocapitate syndrome with more than 30 years follow-up. While the patient experienced midcarpal arthritis, the injury had not resulted in capitate proximal pole avascular necrosis as per T1 magnetic resonance imaging studies. Literature Review Missed and chronic cases of scaphocapitate syndrome were reported previously. Successful outcomes were achieved with anatomical reduction in cases without midcarpal arthritis. Salvage procedures or arthroplasty procedures are recommended with the presence of midcarpal arthritis. However, there are no reports of a neglected case with more than 30 years follow-up with preserved vascularity of the proximal pole of the capitate. Clinical Relevance This case illustrates that vascularity of the proximal pole of the capitate can be preserved even in longstanding displaced fractures.

Keywords: avascular necrosis; capitate; carpal bones; scaphocapitate syndrome; wrist.

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Conflict of interest statement

Conflict of Interest None declared.

Figures

Fig. 1
Fig. 1
Posteroanterior ( A ) and lateral ( B ) radiographs of the left wrist demonstrating scaphoid nonunion advanced collapse changes with scaphocapitate syndrome.
Fig. 2
Fig. 2
Coronal ( A ) and sagittal ( B ) computed tomography cuts demonstrating severe scaphoid nonunion advanced collapse wrist changes with fracture through the radial styloid and capitate fracture with cystic changes supporting an old scaphocapitate syndrome.
Fig. 3
Fig. 3
Coronal magnetic resonance imaging T2 sequence ( A ) demonstrates bone edema of the scaphoid, lunate, and capitate suggesting an acute component to an old fracture. Coronal T1 sequence ( B ) confirms no evidence of avascular necrosis of the proximal pole of the capitate despite 180 degrees displacement (white arrow).
See this image and copyright information in PMC

References

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