Treatment of Isolated Capitate Nonunion With Osteonecrosis Using a Capsular-Based Vascularized Bone Graft

Case: Isolated capitate fracture nonunion is an uncommon injury that rarely demonstrates concurrent osteonecrosis. The literature to help guide treatment is sparse. We present a 24-year-old woman who developed a nonunion through the capitate waist with concurrent osteonecrosis 15 months after injury. This complication was treated with internal fixation and a capsular-based distal radius vascularized bone graft (VBG) from the fourth extensor compartment artery pedicle. The patient achieved radiographic union by 15 weeks and had near complete recovery of motion and strength at the final follow-up. Conclusion: This case supports the use of capsular-based VBG as a technically simple and effective treatment for this rare condition.