{"title":"头颅骨骨折：诊断挑战、治疗策略和长期并发症：叙述性回顾。","authors":"Aidin Arabzadeh, Omid Salkhori, Seyyed Hadi Kalantar, Seyyed Saeed Khabiri, Hamed Naghizadeh","doi":"10.2106/JBJS.RVW.25.00112","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p><p><strong>Level of evidence: </strong>Level V. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"13 8","pages":""},"PeriodicalIF":2.4000,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Capitate Fracture: Diagnostic Challenges, Treatment Strategies, and Long-Term Complications: A Narrative Review.\",\"authors\":\"Aidin Arabzadeh, Omid Salkhori, Seyyed Hadi Kalantar, Seyyed Saeed Khabiri, Hamed Naghizadeh\",\"doi\":\"10.2106/JBJS.RVW.25.00112\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p><p><strong>Level of evidence: </strong>Level V. See Instructions for Authors for a complete description of levels of evidence.</p>\",\"PeriodicalId\":47098,\"journal\":{\"name\":\"JBJS Reviews\",\"volume\":\"13 8\",\"pages\":\"\"},\"PeriodicalIF\":2.4000,\"publicationDate\":\"2025-08-22\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"JBJS Reviews\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.2106/JBJS.RVW.25.00112\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/8/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q2\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"JBJS Reviews","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.2106/JBJS.RVW.25.00112","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/8/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}
Capitate Fracture: Diagnostic Challenges, Treatment Strategies, and Long-Term Complications: A Narrative Review.
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.
期刊介绍：
JBJS Reviews is an innovative review journal from the publishers of The Journal of Bone & Joint Surgery. This continuously published online journal provides comprehensive, objective, and authoritative review articles written by recognized experts in the field. Edited by Thomas A. Einhorn, MD, and a distinguished Editorial Board, each issue of JBJS Reviews, updates the orthopaedic community on important topics in a concise, time-saving manner, providing expert insights into orthopaedic research and clinical experience. Comprehensive reviews, special features, and integrated CME provide orthopaedic surgeons with valuable perspectives on surgical practice and the latest advances in the field within twelve subspecialty areas: Basic Science, Education & Training, Elbow, Ethics, Foot & Ankle, Hand & Wrist, Hip, Infection, Knee, Oncology, Pediatrics, Pain Management, Rehabilitation, Shoulder, Spine, Sports Medicine, Trauma.
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