Capitate Fracture: Diagnostic Challenges, Treatment Strategies, and Long-Term Complications: A Narrative Review.

Abstract

Background: This review aims to synthesize current knowledge on capitate fractures, with an emphasis on diagnostic challenges, therapeutic approaches, and long-term complications, including nonunion and avascular necrosis.

Methods: A narrative literature review was conducted using databases including PubMed, Scopus, and Google Scholar for studies published up to April 2025. Keywords included "capitate fracture," "carpal injuries," "avascular necrosis of the capitate," and "capitate nonunion." Because of the rarity of these fractures, both clinical studies and case reports were included. Articles were selected if they described clinical features, imaging modalities, fracture classification, surgical or conservative treatments, complications, or rehabilitation protocols. Non-English publications and those lacking clinical detail were excluded.

Results: Capitate fractures are rare and frequently missed because of their central anatomic location and variable presentation. Plain radiographs often fail to detect these fractures; however, computed tomography and magnetic resonance imaging significantly improve diagnostic accuracy. Nondisplaced fractures may be treated nonoperatively, whereas displaced or rotated fractures typically are treated with surgical intervention such as open reduction and internal fixation. Avascular necrosis and nonunion, though uncommon, are serious complications requiring individualized surgical management, including bone grafting or salvage procedures. Structured rehabilitation is essential for restoring wrist function and preventing chronic impairment.

Conclusion: Timely recognition and thoughtful management of capitate fractures, including the use of advanced imaging and individualized surgical strategies, may help reduce the risk of long-term complications and support favorable outcomes in select cases. Enhancing clinical awareness and working toward more standardized treatment frameworks could provide better care for these uncommon but potentially significant wrist injuries.

Level of evidence: Level V. See Instructions for Authors for a complete description of levels of evidence.