Capitate fracture nonunion in association with triquetrum avulsion fracture: Rare injury with massive effect on hand function, a case report

INTRODUCTION AND IMPORTANCE: Capitate fractures are rare and usually occur due to high-energy trauma. They are often associated with other wrist injuries or dislocations. An isolated occurrence of capitate and triquetral fractures due to high-energy trauma is rarely reported in the literature. This rare injury pattern has a significant effect on wrist function, as presented in this case. CASE PRESENTATION: A 19-year-old male manual worker, presented with persistent right wrist pain and progressive loss of function after sustaining motor vehicle collision 5 months prior. The patient had major concerns regarding the return of wrist function. CLINICAL DISCUSSION: A diagnosis of collapsed capitate fracture nonunion associated with a triquetral avulsion fracture was made based on radiography, computed tomography (CT) scan, and magnetic resonance imaging (MRI). Treatment with internal fixation and strut corticocancellous autograft to restore capitate height resulted in substantial improvement in wrist function and alleviation of pain. The Mayo wrist score increased from 15/100 to 90/100 at the 6-year follow-up visit. CONCLUSION: Capitate fractures can occur in association with triquetral fractures in the absence of dislocation or greater arch injuries. Nonunion is a common complication, and internal fixation with bone graft is the gold standard for the treatment of capitate fracture nonunion, resulting in excellent outcomes and return of function.