[Avascular necrosis of the hamate--case report]

Medial femoral condyle free flap for carpo-metacarpal instability following hamate comminute fracture

Complete reconstruction of the hamate bone has been reported in the literature mostly following cancer excision or avascular necrosis. For the exiguity of the tissue deficit, bone grafting has usually been used as treatment option for its rapidity and easiness to perform, even if a variable amount of bone resorption may occur. In traumatic cases, microbial contamination may jeopardize the success of a well performed bone graft and vascularised bone grafts may represent a better reconstructive option. Here we describe the first case reported in the literature of a patient underwent complete hamate reconstruction following trauma with an osseous medial femoral condyle free flap as vascularized arthrodesis between the capitate and the 4th MTC base, in order to stabilize the 4th and 5th finger and the ulnar carpo-metacarpal joint.

Avascular Necrosis of Capitate and Other Uncommon Presentations of Carpal Avascular Necrosis

Outside of Preiser and Kienbock disease, avascular necrosis (AVN) of the remaining carpal bones is a rare cause of wrist pain and disability with a natural history that is incompletely understood. At present, much of the available clinical information exists in the form of isolated case reports or small case series. Although reported surgical treatment options are numerous, there is a dearth of comparative studies and long-term outcomes data with which to guide management.

Avascular necrosis of the hamate: three cases and review of the literature

Background Avascular necrosis of the hamate (hamate-AVN) is a seldom reported disease of which little is known on etiology, best treatment modalities, and outcome. Hamate-AVN can occur in multiple locations within the hamate. Case Description Case one was an 8-year-old girl with painful AVN of the hamate hook. Surgical excision of the hook was performed, leading to excellent results (follow-up 8 years). Case two was a 44-year-old man with hamate-AVN of the proximal pole surgically treated with a vascularized bone graft from the radius based on the fifth extensor compartment artery, leading to excellent results (follow-up 7 years). Case three was a 36-year-old woman with hamate-AVN of the proximal pole surgically treated with débridement and cancellous bone grafting, leading to poor results (follow-up 1 year). Literature Review Nine other cases of avascular necrosis of the hamate were found in literature, all but one treated surgically. Etiology, treatment, and results of these cases, combined with our own cases, are reviewed. Clinical Relevance This article summarizes and synthesizes all presented cases of avascular necrosis of the hamate. We hope this will be helpful to physicians in decision making when confronted with this rare entity. Level of Evidence 4.

Avascular necrosis of the hamate treated with capitohamate and lunatohamate intercarpal fusion

This article describes a case of a 58-year-old man with no significant underlying disease who had chronic pain due to osteonecrosis of the hamate. Following physical examination, imaging, and laboratory findings, he underwent surgical exploration via a limited dorsal approach. The hamate bone did not have a normal anatomical appearance or structure. It was marble-like in appearance, soft, friable, and lacking physiologic contour and bone strength. We removed the dorsal aspect of the hamate piecemeal. The articular surfaces of the adjacent carpal bones (capitate and lunate) were excised, and the lesion was packed with iliac autograft. Three months postoperatively, fusion of the remaining hamate and the adjacent capitate and lunate carpal bones was evident, and the patient reported mild wrist pain, moderate grip strength improvement, and mild improvement of wrist range of motion and stiffness. Currently, no standard treatment algorithm exists for patients with avascular necrosis of the hamate. However, delayed diagnosis of this clinical entity can be debilitating. A high index of clinical suspicion and an early course of treatment offers considerable benefits to patients with osteonecrosis of the hamate.