Sonographic Diagnosis of a Radiographically Undiagnosed Hook of the Hamate Fracture

Abstract

Abbreviations CT, computed tomography; HH, hook of the hamate Case ReportA 54-year-old right-handed woman was referred by a hand surgeon because of local pain in the ulnar aspect of the right wrist radiating down into the fourth and fifth fingers. She had a fall on both wrists 4 months previously. Standard anteroposterior and lateral radiographs obtained after the accident showed a displaced fracture of the left distal radius but no traumatic lesions of the right wrist. She was successfully treated by osteosynthesis of the left radius. After 4 months, because of persistent pain in the right wrist, she consulted a hand surgeon, who asked for an sonographic examination to rule out tenosynovitis of the flexor tendons.Clinical examination showed a normal appearance of the hand and wrist without local swelling or redness. Case Report ractures of the hook of the hamate (HH) account for approximately 2% of wrist fractures and can follow local acute trauma or chronic overuse in racket, club, and bat sports, mainly tennis, golf, and baseball. Because of limitations in detecting them on standard radiographs, they can go easily undiagnosed. When unrecognized, they can evolve into painful nonunions and can be followed by local complications such as tenosynovitis and tendon rupture of the flexor tendons of the fourth and fifth fingers as well as impingement on the ulnar nerve and artery. Because of recent technical improvements, sonography is nowadays considered a useful imaging technique in the assessment of musculoskeletal disorders, including traumatic soft tissues lesions. In addition, fractures that are difficult to diagnose by standard radiography can be detected by sonography because of its tomographic capabilities. We report a case of a fracture of the HH diagnosed by sonography that was undetected on standard radiographs.

Lessons to be learned from a missed case of Hamate fracture: a case report

“…This case highlights some of the problems encountered with traditional x-ray views, and the need to consider oblique views as either standard procedure or as an adjunct where clinical suspicion remains high even in the presence of normal x-rays. This point remains valid even given the increasing use and availability of other forms of radiological investigation [6-9]. …”

Stress Fractures of the Calcaneus Diagnosed by Sonography: Report of 8 Cases

“…The normal periosteum, depending on its thickness, can sometime difficult to assess by sonography. Due to its tomographic capabilities, sonography can show acute fractures that are difficult to image on radiography and can show a variety of stress fractures . A recent study on sonographic and radiographic capabilities in the early detection of metatarsal stress fractures showed that sonography had sensitivity of 83% and specificity of 76% (correlated with MRI) and that sonography was more sensitive than standard radiography for this purpose …”

Fracture du hamatum chez un boxeur professionnel

“…Les fractures du hamatum (os crochu) sont rares, en particulier celles intéressant le corps, et ne constituent que 2 % de toutes les fractures du carpe [1,2]. Elles ne sont pas souvent évoquées comme diagnostic différentiel devant un traumatisme carpien et peuvent passer inaperçues.…”

“…La TDM reste l'examen de choix dans le diagnostic de ce type de fracture en précisant les traits fracturaires et le nombre de fragments ainsi que leur possible déplacement [2]. Dans une étude faite sur 18 mains de cadavres, la TDM avait une sensibilité de 100 % et une spécificité de 94,4 % alors que la radiographie conventionnelle a montré une sensibilité de 72,2 % et une spécificité de 88,8 % [5].…”