We report a rare case of capitate osteonecrosis in a 51-year-old woman with thalassemia presenting with persistent wrist pain. Imaging findings were consistent with osteonecrosis of the capitate, and the patient underwent surgical treatment with a vascularized bone graft from the second metacarpal and cancellous bone graft from the iliac crest. Histopathological examination confirmed ischemic osteonecrosis. At 15 months after surgery, clinical improvement was limited; however, magnetic resonance imaging demonstrated preservation of capitate morphology and reduced signal abnormalities. Capitate osteonecrosis in patients with thalassemia is extremely rare but should be considered in the differential diagnosis of wrist pain. Early recognition may facilitate timely intervention and help prevent disease progression.
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