Simultaneous fractures of the capitate and hamate in the coronal plane: case report

Hamate Body Fractures: a Comprehensive Review of the Literature

PURPOSE OF REVIEW

Due to the rarity and often discrete nature of hamate body fractures, timely diagnosis requires a high level of suspicion on the part of the clinician. Here, the authors have compiled the findings from 6 cohort studies and 33 case reports describing hamate body fractures in order to summarize the natural history, management, and outcomes of these infrequent injuries.

RECENT FINDINGS

Fractures of the hamate body typically occur in the coronal plane through axial loading of the metacarpals or loading in the transverse plane by a compressive force. Standard radiographs of the wrist frequently miss hamate fractures. Oblique and carpal tunnel views can be obtained when a fracture of the hamate is suspected. Advanced imaging with high-resolution computed tomography should also be considered if radiographs are negative and high suspicion for fracture remains or for the purpose of pre-operative planning. Co-existing injuries often include subluxation or dislocation of the 4th and 5th metacarpals with or without fracture. Non-displaced injuries that are stable may be treated non-operatively with immobilization. Displaced or unstable fracture patterns typically require closed reduction and percutaneous pinning versus open reduction internal fixation in order to restore anatomical alignment and maximize outcomes. Hamate body fractures are uncommon fractures of the carpus. When appropriately treated, patients with hamate body fractures usually recover full pain-free range of motion and preserved grip strength. Complications are usually secondary to late presentation or noncompliance.

Hamate's coronal fracture: diagnostic and therapeutic approaches based on a long-term follow-up

Hamate fractures are commonly divided into hook fractures and body fractures. The coronal fractures as a special form of hamate’s body fracture are very rare injuries. Because of unspecific clinical findings and the mostly inconclusive x-ray imaging, these fractures are frequently overseen or misdiagnosed. This leads to further complications like secondary arthritis, persisting pain, and functional deficits in patient’s wrist mobility. In our study, a collocation of coronal hamate fractures is analyzed and evaluated with respect to functional outcome after operative treatment and compared to the literature. Furthermore, we compare the strategies for diagnosis and treatment in our clinical center with those presented in the literature.

Our standard in the initial diagnostic process is to obtain radiographs in an anterior-posterior, lateral, and 30° oblique view of the wrist. For further diagnosis and preoperative planning, a CT scan of the wrist is obligatory. Due to the high occurrence of comorbidities (especially CMC dislocations) all patients in our cohort obtained operative treatment.

In long-term post-operative evaluation, we present the following results:

The Manchester-Modified Disability of the Shoulder, Arm and Hand Score (M² DASH) imposed with an average of 26.22 points (MD=22/ SD=11.31/MIN=18/MAX=52). None of the re-evaluated patients sorrowed for severe pain in rest. Four patients stated pain (ranging from 3 to 5 on numeric analogue scale) after heavy burden (e.g. boxing, weight lifting). In exploring the range of motion of the operated hand the following results are obtained: dorsal extension: average 83.33° (MD=85°/SD=3.54°/MIN=75°/MAX=85°), flexion: average 77.78° (MD=80°/SD=4.41°/MIN=70°/MAX=80°). Additionally, a performance testing was conducted: fist clenching sign: complete without pain in 100%, pinch grip: complete in 77.78%, opposition digitus manus I–V complete in 66.67%.

The conservative treatment is not recommended (especially shown in the here presented “add” case with a misdiagnosed fracture). The open approach has its advantages compared to a closed operative procedure and should always be intraoperatively considered as an operative expansion.

Pancarpal dissociation with palmar Capitate fracture-dislocation: Case report

Capitate fractures are rare and dislocations are even more uncommon. To our knowledge, there has been no report of a Capitate fracture with complete dislocation in the literature. Here, we present the first case of a Capitate fracture-dislocation, sustained after a motorcycle accident.

Hamate fractures

OBJECTIVE

The purpose of this paper is to present our experience in the treatment of the fractures of the hamate and to make a review of the literature on this topic.

MATERIAL AND METHOD

We retrospectively reviewed 10 patients treated in our clinic between 2005-2012 suffering from fractures of the hamate. Six cases were fractures of the body and four were fractures of the hamate. Five cases were of associated injuries. Diagnostic delay ranged from 30 days to 2 years. Patient follow-up ranged from 1 to 10 years. Patient satisfaction was evaluated using the DASH questionnaire. Five patients with a fracture of the body underwent surgery, and one was treated conservatively. Two patients with fracture of the hook of the hamate were treated with immobilization, and two more patients had the fragment removed.

RESULTS

The grip strength and the digital clip were reduced in 2 cases. Flexion and extension of the wrist was limited in 3 cases. The mobility of the fingers was normal in all the cases, except in one. The results obtained from the DASH questionnaire were normal in all the cases, except in one case of fracture of the hamate, and in two cases of fracture of the body.

CONCLUSIONS

The surgical treatment should reduce the dislocation and stabilize the injuries with osteosynthesis. The fractures of the hamate are usually diagnosed late, and the most recommended treatment is removal of the fragment, although it cannot be deduced from this study.

A rare coronal fracture of the medial carpal column: Case report

Carpal coronal fractures are rare. We report the case of a 15 year-old male who fell from a balcony and suffered a displaced coronal fracture of the capitate, hamate and triquetrum. The diagnosis, which was initially made based on the X-rays, was confirmed by CT scan. Open reduction and internal fixation using Herbert screws was performed. To the best of our knowledge, this is the first published case of a coronal fracture of these three bones. The patient returned to normal activities after six months.

Fractures of the hamate and pisiform bones

Osseous injuries to the ulnar aspect of the carpus are increasing in frequency because of greater participation in sporting activities. Hamate body fractures are subdivided into coronal, sagittal oblique, proximal pole, and medial tuberosity fractures. Successful treatment of coronal fractures requires identification and treatment of associated disruption or instability of the ulnar 2 carpometacarpal joints. Displaced hamate hook fractures are optimally treated with early excision to avoid sequelae such as flexor tendon and nerve injury, and to allow early return to activity. Undisplaced pisiform fractures are managed nonoperatively, whereas displaced fractures and nonunions are treated by simple excision.

A case report of coronal fractures through the hamate, the capitate, and the trapezoid

To our knowledge, the simultaneous coronal fractures of the hamate, capitate, and trapezoid have not been previously reported in the literature. There were few reports about coronal fractures of the hamate caused only by axial loading to the ulnar column. We report 43-year-old man who presented with painful swelling on the dorso-ulnar side of the wrist after striking a wall with his right clenched fist. The computed tomography scan demonstrated coronal fractures through the hamate, capitate, and trapezoid. We performed closed reduction and fixation with a percutaneous compression screw. At the last follow-up, the patient was able to return to sports activities without any symptoms.