Delayed diagnosis and surgical management of an isolated capitate fracture: A case report with two-year follow-up.

Introduction: Isolated capitate fractures are among the rarest carpal injuries and often remain undetected due to subtle radiographic findings and the bone's central location within the carpus. When diagnosis is delayed, complications such as nonunion and avascular necrosis (AVN) may develop, requiring advanced surgical management.

Case Presentation: A 20-year-old male manual laborer presented with persistent wrist pain and restricted motion six months after a motorcycle accident. Initial radiographs failed to detect a fracture. Subsequent imaging, including computed tomography (CT) and magnetic resonance imaging (MRI), revealed an isolated capitate fracture with nonunion and diffuse AVN. The patient underwent surgical treatment consisting of resection of the necrotic proximal capitate pole, dorsal capsular interposition, Kirschner wire (K-wire) fixation of the distal fragment, and core decompression to enhance vascularity. Early rehabilitation was implemented. At the two-year follow-up, the patient had regained pain-free wrist motion, and imaging showed no progression of AVN or development of osteoarthritis.

Discussion: The capitate's predominantly retrograde blood supply makes it particularly prone to AVN. In cases with delayed presentation, internal fixation may be unfeasible, and joint-sparing salvage procedures become necessary. Our approach preserved motion and avoided wrist arthrodesis. Early, structured rehabilitation was essential to achieving functional recovery.

Conclusion: This case illustrates the value of early recognition and customized management in isolated capitate fractures complicated by AVN. Non-arthrodesis surgical techniques, combined with early rehabilitation, can yield excellent long-term outcomes, particularly in young, active patients.