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

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

“…Fractures of the metacarpal bones IV and V as well as dislocations in the carpometacarpal joints can be accompanied by coronal fractures of the hamate [ 1 ], [ 2 ], [ 7 ], [ 8 ], [ 9 ], [ 10 ], [ 11 ], [ 12 ], [ 13 ], [ 14 ], [ 15 ], [ 17 ], [ 18 ], [ 19 ], [ 20 ], [ 21 ], [ 22 ], [ 23 ], [ 25 ], [ 26 ], [ 34 ], [ 35 ], [ 36 ], [ 37 ]. Therefore, a restricted mobility and function ensues [ 38 ], [ 39 ].…”

“…Other mechanisms of trauma are less frequent. Mainly, the fracture occurs after a transmission of forces along the fourth metacarpal (MC) axis [ 1 ], [ 5 ], [ 6 ], [ 7 ], [ 10 ], [ 11 ], [ 12 ], [ 14 ], [ 15 ], [ 20 ], [ 21 ], [ 24 ], [ 35 ], [ 36 ], [ 37 ], [ 42 ]. In a radial-deviated and about ten degree flexed fist, the distal part of the fourth MC bone stands upon the other anatomical structures and is the main point for loading the forces in a situation of falling or punching [ 11 ], [ 12 ].…”

“…Typically, the coronal fracture of the body of the hamate imposes with a dorso-ulnar pain, accentuating by manual pressing or passive movement, dorsal ecchymosis and swelling [ 1 ], [ 2 ], [ 4 ], [ 5 ], [ 6 ], [ 7 ], [ 8 ], [ 11 ], [ 12 ], [ 13 ], [ 14 ], [ 15 ], [ 17 ], [ 18 ], [ 19 ], [ 20 ], [ 22 ], [ 26 ], [ 35 ], [ 37 ], [ 40 ], [ 43 ]. Further and more suspicious findings in clinical evaluation are caused by specific complications of the coronal fracture: palsy of motor branch of ulnar nerve, fractures of fourth and/or fifth MC, dislocations or sub-dislocations of CMC four and/or five, soft tissue damage, rupture of dorsal ligaments or rupture of extensor tendons.…”

“…This causes a piano key phenomenon on the dorso-ulnar hand [ 11 ], [ 36 ] due to the mainly dorsally displaced MC base [ 1 ], [ 2 ], [ 7 ], [ 8 ], [ 10 ], [ 13 ], [ 14 ], [ 25 ], [ 35 ], [ 36 ], [ 43 ]. Furthermore, it leads to a weakened grip strength, limited opposition ability, pain accentuation by pressing along the MC axis and restricted mobility in CMC joints [ 6 ], [ 11 ], [ 12 ], [ 13 ], [ 14 ], [ 15 ]. The displacement is caused by a rupture of the interosseous ligaments that tie the metacarpals together.…”

“…The coronal fracture in general appears mostly after punch injuries with a radial-abducted and approximately 10° flexed hand [ 11 ], [ 12 ] against an unyielding object [ 2 ], [ 4 ], [ 5 ], [ 7 ], [ 8 ], [ 9 ], [ 10 ], [ 11 ], [ 12 ], [ 13 ], [ 14 ], [ 15 ], [ 16 ], [ 17 ], [ 18 ], [ 19 ], [ 20 ], [ 21 ], [ 22 ].…”