An unusual coronal fracture of the body of the hamate bone

Kimura, Hideya; Kamura, Souichirou; Akai, Masami; Ohno, Tohgo

doi:10.1016/s0363-5023(88)80139-4

Cited by 17 publications

(16 citation statements)

References 4 publications

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“…They also showed that wrist palmar flexion could produce dorsal displacement of the hamate fracture fragment. In case 1, as well as in another case reported in the literature (5), where the patient punched a resistant object with a closed fist, the usual result is a boxer's fracture. However, it has been demonstrated that coronal fractures of the body of the hamate can occasionally occur when the wrist is ulnar deviated and palmar flexed (5) at the start of a punch.…”

Section: Discussionmentioning

confidence: 80%

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Coronal fractures of the body of the hamate: Two case reports

Binhammer¹,

Rao²

1998

CAN J PLAST SURG

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Fractures of the hamate were classified by Milch (1) into body fractures and hook fractures; fractures of the body of the hamate were subdivided into those occurring on the radial side and those occurring on the ulnar side of the hook. Bowen (2) presented a hamate fracture in the coronal plane and, therefore, added a third category -fractures to the body of the hamate. The two cases described in this report are examples of this rare type of fracture; both were associated with disarticulations at the base of the fourth and fifth metacarpals. Open reduction and internal fixation led to rapid recovery in terms of stabilization of the hamatometacarpal joint and restoration of hand function. CASE PRESENTATIONS Case 1A 29-year-old, right-hand dominant woman was referred five days after punching a steel door with her closed right fist. She was seen by physicians at the emergency department of a local hospital, where she was placed in a fibreglass splint after reduction of the fifth metacarpal.Follow-up physical examination revealed minimal to moderate swelling and ecchymosis over the base of her right fifth metacarpal. X-rays revealed a hamate intra-articular fracture with the fifth carpometacarpal joint (Figure 1). Displacement was noted to be approximately 3 to 4 mm. An open reduction was recommended to reduce the dislocated fragment of the hamate, and eight days after the injury, the patient underwent open reduction and internal fixation.Maintenance reduction of the fifth metacarpal was achieved by two 1.1 mm Kirschner wires driven between the fourth and fifth metacarpals. The dislocated fragment of the hamate was positioned and fixed in place with a 0.7 mm Kirschner wire. Two 1.2 mm screws were then used with a plate over the fragment, and the 0.7 mm Kirschner wire was removed. The hand and wrist were immobilized by a volar plaster splint for three weeks, at which time it was replaced by a short-arm cast to immobilize the extremity for an additional three weeks. Six weeks after the operation, the Kirschner wires were removed (Figure 2). The patient returned to full activities by 12 weeks after surgery and was asymptomatic when seen at eight months postsurgery.Can J Plast Surg Vol 6 No 2 Summer 1998 81 CASE REPORTCorrespondence: Dr PA Binhammer, Sunnybrook Health Science Centre, H-210, 2075 Bayview Avenue, North York, Ontario M4N 3M5. Telephone 416-480-6731, fax 416-480-6800, e- Coronal fracture of the body of the hamate with associated dorsal dislocation at the bases of the fourth and fifth metacarpals is rare. Two cases of this injury, treated with open reduction and internal fixation, are reported. As well, other reports of coronal hamate fractures are reviewed.

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Section: Discussionmentioning

confidence: 80%

“…Loth and McMillan (6) also described a coronal hamate fracture caused by the impact of an object on the dorsum of the hand. Coronal fractures of the hamate may be missed (4)(5)(6)(7)(8). This is because not all fractures are apparent from routine x-ray views of the wrist.…”

Section: Discussionmentioning

confidence: 99%

Coronal fractures of the body of the hamate: Two case reports

Binhammer¹,

Rao²

1998

CAN J PLAST SURG

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“…With our technique, good results have been achieved as has been noted by other authors. 5,[18][19][20] A high index of suspicion is necessary when assessing patients on initial presentation. In our series, five of the six patients were underdiagnosed on initial plain imaging read by an attending radiologist.…”

Section: Discussionmentioning

confidence: 99%

Carpometacarpal 4/5 Fracture Dislocations: Fracture Morphology and Surgical Treatment

Verhiel

Knaus

Simeone

et al. 2020

Journal of Hand and Microsurgery

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We conducted a retrospective review of six patients with carpometacarpal (CMC) ⅘ fracture-dislocations managed with ORIF by a single surgeon between October 2006 and August 2017. An open, dorsal approach to the hamate was used with a combination of interfragmentary screw fixation and Kirschner wire reduction in the CMC joints. At a mean of 96 days follow-up (range: 31–265), all patients had recovered wrist motion, excellent grip strength, and complete resolution of pain. There were no complications or reoperations during the postoperative period. Radiographic review showed restoration of anatomy and well-maintained congruity of the CMC joints. Our study has shown favorable outcomes after open reduction and internal fixation of the hamate body fracture with interfragmentary screws, when combined with stabilization of the CMC dislocation with percutaneous Kirschner wires. Fracture morphology does not appear to guide choice for specific hardware (size screw, headed/headless) or use of a washer. This is a level IV, therapeutic study.

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“…Stability is further reinforced by broad insertions of the wrist flexors and extensors, though, dorsal dislocation is prevented only by the dorsal ligament [6]. Coronal fractures of the hamate have been shown to occur when a force is transmitted longitudinally along the lesser metacarpals (4 th , 5 th ) with the wrist in ulnar deviation as, in a neutral position, the same force would most probably cause a boxer’s fracture [9, 10]. Additionally, palmar flexion of the wrist at the moment of impact will result in the dorsal displacement of the involved metacarpals due to the obliquity of the fifth CMC joint and the pull of extensor carpi ulnaris (ECU) and flexor carpi ulnaris (FCU) tendons along with the hypothenar muscles [11].…”

Section: Discussionmentioning

confidence: 99%

Fracture of the Body of the Hamate With Dorsal Dislocation of the 4th and 5th Metacarpals: A Case Report

Athanasiou¹,

Iliopoulos²,

Pantazis³

et al. 2017

TOORTHJ

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Background:Solitary fractures of the body of the hamate are rare. Their diagnosis is difficult and requires a high clinical suspicion and a proper radiological examination.Case report:We present a case of a 36-year-old male patient who sustained an intraarticular fracture of the body of the hamate along with dorsal dislocation of the 4th and 5th metacarpals on his right dominant hand. Through a dorsal surgical approach, he underwent ORIF of the hamate with screws and stabilization of the dislocated 4th and 5th metacarpals with KW. At his last follow-up appointment, 18 months postoperatively, he had no pain, almost full range of motion on his fingers and a Mayo Wrist score of 90 points.Conclusions:Hamate fractures are rare entities that can cause significant patient morbidity if not recognized and treated appropriately.

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An unusual coronal fracture of the body of the hamate bone

Cited by 17 publications

References 4 publications

Coronal fractures of the body of the hamate: Two case reports

Coronal fractures of the body of the hamate: Two case reports

Carpometacarpal 4/5 Fracture Dislocations: Fracture Morphology and Surgical Treatment

Fracture of the Body of the Hamate With Dorsal Dislocation of the 4th and 5th Metacarpals: A Case Report

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