Hamate fractures are rare. Their treatment depends on the displacement and type of fracture. We present the case and surgical technique of a 33-year-old male patient, who is a manual worker, with a displaced fracture of the body of the hamate bone associated with dislocation of the fourth and fifth metacarpal (MC) bones. The patient was operated on with a double palmar and dorsal approach directly over the hamate and the body hook, respectively, which was performed to improve the control reduction and avoid damaging the neighboring vascular and nerve structures. The open reduction internal fixation (ORIF) was performed by inserting mini-screws in a dorsal to palmar direction. Later, the dislocations were reduced and fixed with Kirschner wires between the fourth and fifth MC bases, and between the fourth MC base and the capitate bone. The patient was discharged 2.5 months after the fracture. The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire outcome measure was 5 points at 6 months postsurgery.
Palabras Clave► fractura del ganchoso ► fractura del carpo ► reducción abierta y fijación interna ► luxación carpometacarpiana ► doble abordaje dorsal y volar
ResumenLas fracturas del ganchoso son poco frecuentes y el tratamiento depende del desplazamiento y tipo de fractura. Se describe la actualidad del tema, y el caso y técnica quirúrgica de un varón de 33 años, trabajador manual que sufre una fractura desplazada del cuerpo del hueso ganchoso, con luxación asociada del 4°y 5°metacarpianos. El paciente fue intervenido realizando un doble abordaje volar y dorsal directo al gancho y cuerpo del ganchoso respectivamente para mejorar el control de la reducción y evitar el daño de las estructuras vasculo-nerviosas vecinas. Se osteosintetizó con tornillo desde dorsal a volar y redujeron y fijaron las luxaciones con agujas de Kirschner entre las bases del 4°y 5°MTC; y base de 4°MTC y hueso grande. Fue dado de alta a los 2,5 meses de la fractura. El cuestionario DASH fue de 5 puntos a los 6 meses post fractura.
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