Reverse Hemi-Hamate Autograft for Volar Proximal Interphalangeal Joint Fracture-Dislocations.

Volar proximal interphalangeal joint fracture-dislocations are rare injuries. Treatment is challenging when they are not identified acutely, with poor outcomes reported. We report a surgical technique to treat chronic volar proximal interphalangeal joint fracture-dislocations: a reverse hemi-hamate autograft.

Excision of the hook of hamate in athletes using the carpal tunnel approach.

BACKGROUND: Hook of the hamate fractures can be managed conservatively or fixed using a screw, but excision is recommended for prompt return to activities. Although various approaches have been described, there is no gold standard. Herein, the authors have described their clinical experiences in excising the hook of the hamate using the carpal tunnel approach, in athletes. METHODS: A total of 36 athletes underwent excision of the hamate hook using the carpal tunnel approach. The mean age of the patients was 23 years, and most of them were baseball players (n = 31). RESULTS: The mean operation time was 33 min. None of the patients presented with any complications aside from transient pillar pain in five cases. All of them returned to their sports activities within an average of 27 days. CONCLUSIONS: In our study, excision of the hook of the hamate was performed safely via the carpal tunnel. The carpal tunnel approach reportedly provides superior benefits over other approaches.

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.

Ulnar-Sided Wrist Pain in the Athlete: Sport-Specific Demands, Clinical Presentation, and Management Options.

ABSTRACT: Ulnar-sided wrist injuries are common in sports that require repeated pronosupination, wrist radial/ulnar deviation, axial loading, and gripping equipment. Common anatomic structures affected include the triangular fibrocartilage complex, extensor carpi ulnaris tendon, distal radioulnar and ulnocarpal joints, and hamate bone. Presenting symptoms include pain with activity, swelling, possible snapping or clicking, and reproduction of symptoms with provocative maneuvers. Imaging may confirm or rule out pathologies, but abnormal findings also may present in asymptomatic athletes. Initial treatment is usually nonoperative with splinting, load management, activity modification, strengthening the components of the kinetic chain of the particular sport, and pain management. Surgery is usually indicated in ulnar-wrist pain pathology such as hook of hamate fractures and required in associated instability. Future research should address specific treatment and rehabilitation protocols, emphasizing the complete kinetic chain along with the injured wrist.

Radiographic signs of hook of hamate fracture: evaluation of diagnostic utility.

OBJECTIVE: Hook of hamate fracture, the most common swing-related wrist fracture, is commonly seen in high-level athletes. The fracture is rarely diagnosed on routine wrist radiographs, thus generally requiring CT or MR for diagnosis. Surgical excision has a high success rate, however diagnostic delay contributes to a high complication rate. Radiographic signs of hook of hamate fracture have been published, but uncertainty of the diagnostic accuracy limits application. The purpose of this study is to determine accuracy and interobserver reliability of radiographic signs of hook of hamate. MATERIALS AND METHODS: This retrospective case-control study evaluated wrist radiographs of 50 patients, including 24 positive and 26 negative, for hook of hamate fracture, each proven by CT or MR. Five reviewers performed blinded, randomized evaluation of radiographs documenting whether the hook of hamate was normal or fractured, and if fractured, the radiographic signs present (ring sign, ghostly shadow, and diffuse sclerosis) and views that contributed to diagnosis. RESULTS: Radiographic signs demonstrated high sensitivity (85%; 95% CI: 77-91), specificity (92%; 95% CI: 86-96), and accuracy (89%; 95% CI: 84-92) with substantial interobserver reliability (k = 0.652). The ring sign was the most sensitive radiographic sign. Diagnosis was most often supported by the oblique view (38%) and rarely the lateral view (15%). CONCLUSIONS: Radiographic signs of hook of hamate fracture on routine radiographs can accurately and reliably diagnose hook of hamate fractures. Evaluation for discontinuity of the cortical ring will optimize sensitivity, allowing for timely diagnosis and treatment, and a reduction of complications.

A Modified Surgical Approach Through Guyon's Canal and the Proximal Ulnar Border of the Carpal Tunnel Allows for Safe Excision of the Hook of the Hamate.

Hook of the hamate fractures can be treated by various methods including cast immobilization, open reduction, and internal fixation and excision. Usually, those individuals who elect for excision have acute fractures and need to return to sporting activity or work quickly or have nonunions with persistent symptoms. There is a paucity of descriptions in the literature and textbooks of a technique to safely excise the hook of the hamate. The authors present a method of safely exposing and removing the hook of the hamate by visualizing the potential structures at risk: the motor branch of the ulnar nerve, the ulnar digital nerve to the little finger, and the flexor tendons to the ring and little fingers by an approach through Guyon's canal and the proximal ulnar border of the carpal tunnel.

Minimally Invasive Fixation With a Volar Approach Using a Cannulated Compression Screw for Acute Hook of Hamate Fractures.

PURPOSE: Optimal treatment of acute hook of hamate fractures (HHF) remains controversial. Isolated acute HHF can be treated nonsurgically or surgically (with excision of the hook or open reduction internal fixation). The authors present the functional outcomes of a case series of patients who were treated with minimally invasive volar fixation for acute HHF. METHODS: This retrospective study reviewed 6 patients with nondisplaced acute HHF treated with a minimally invasive volar approach and cannulated mini-screw fixation. The development of postoperative complications (tendon and ulnar nerve lesions), pain evaluated using a visual analog scale, and radiological union evaluated on computed tomography scan is reported. Wrist range of motion and grip strength were measured bilaterally. Mayo Wrist Score and Quick-Disabilities of the Arm, Shoulder, and Hand were assessed. All outcomes were measured at 1, 2, 3, and 6 months after surgery. RESULTS: Fixation of HHF through the volar approach was achieved in all cases with no complications. The clinical and radiological union rate was 100%. All patients were able to return to their work or hobbies after an average of 7 weeks. CONCLUSIONS: This study suggests that acute HHF can be treated successfully by open reduction internal fixation using a volar approach with minimal morbidity and complications, a good union rate, and a fast return to daily activities. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic V.

Dorsal buttress plate fixation for the treatment of fracture-dislocation of the fifth carpometacarpal joint with avulsion fracture of the hamate: a case report.

Fracture-dislocations of the fourth and fifth carpometacarpal (CMC) joints present a complex situation. Misdiagnosis and inadequate treatment may cause malunion and residual subluxation, which lead to painful arthritis and grip weakness. Open reduction along with internal fixation is the treatment of choice, but there is no consensus on an optimal treatment approach. We applied a novel surgical technique to treat a case of a fracture-dislocation of the fifth CMC joint with avulsion fracture of the hamate using a dorsal buttress plate between the hamate and the capitate. This method allowed for achieving rigid fixation without screw insertion across the bone fragments of the hamate. We could avoid the risk of unexpected fragmentation and unexpected damage to the volar neurovascular bundles around the hook of the hamate. Six months postoperatively, bone union was achieved and the reduction of the fourth and fifth CMC joints was maintained. Range of motion of the fourth and fifth CMC joints was almost equal to that on the contralateral side. Dorsal buttress plating between the hamate and the capitate could be an alternative technique for the treatment of fracture-dislocation of the fifth CMC joint with avulsion fracture of the hamate.

Diagnosis of a hamate hook fracture with 3D reconstruction of computed tomography images: A case report and review of literature.

We report the case of a 19-year old man who presented to our institution with a history of pain of one week in the ulnar side of the left wrist and continuous pressing sensation in the palm. According to patient, there was no history of acute hand trauma. The conventional roentgenograms did not show the fracture and computerized tomographic (CT) scanning demonstrated a complete fracture of the hook of the hamate. The patient was given a surgical intervention and the hamate bone was reduced through a palmar skin incision. After surgery, the operated hand was immobilized in a wrist brace and the patient was put on a rehabilitation protocol. At the last follow-up, the patient was able to return to normal living activities without any symptoms. We reviewed the latest articles of the past 18 years and compared the research studies related to the diagnosis and treatment of the hamate hook fracture. Our conclusion is that CT scan is the most effective diagnostic tool for detecting the hamate hook fracture. Three-dimensionally (3D) reconstructed images based of CT could provide more accurate and insight illustration for better evaluation in surgical planning.

Concomitant hook of hamate fractures in patients with scaphoid fracture: more common than you might think.

OBJECTIVE: The scaphoid is the most commonly fractured carpal bone. The presence of a concomitant hook of hamate fracture is of particular relevance given that it is often occult on routine wrist/scaphoid radiographs and that hook of hamate fractures are prone to symptomatic non-union, resulting in chronic ulnar wrist pain. Prompt diagnosis and immobilisation/fixation may minimise such complications. Our study is aimed at assessing the frequency of concomitant hook of hamate fractures in patients with scaphoid fractures. METHODS: Hook of hamate fracture is often occult on wrist/scaphoid radiographs. Hence, we identified all 2,568 CT and MRI studies performed to investigate scaphoid fracture at our institution from April 2005 to March 2016. Three hundred and twelve out of 2,568 cases were confirmed to have a scaphoid fracture. Images were then retrospectively reviewed by a Consultant Musculoskeletal Radiologist and Musculoskeletal Radiologist Trainee to assess for the presence of concomitant hook of hamate fracture and, if present, whether this was identified on initial reporting. RESULTS: Concomitant hook of hamate fracture was identified in 10.3% of cases (32 out of 312, 30 on CT, 2 on MRI); most were minimally/non-displaced. Sixty percent of fractures identified on CT were missed on the initial review (18 out of 30). Both cases identified on MRI had been initially reported. CONCLUSION: Scaphoid fracture is associated with higher than expected rates of concomitant hook of hamate fracture. Given the potential morbidity associated with hook of hamate fracture, this should be considered a review area when investigating scaphoid injury. These fractures are often minimally displaced, hence easily overlooked on CT. MRI may therefore be superior when investigating radiographically occult scaphoid fractures.

Rock Climbing-Related Bone Marrow Edema of the Hand: A Follow-up Study.

OBJECTIVE: Sport climbers strain passive and active anatomical structures of their hands and fingers to the maximum during training or competition. This study was designed to investigate bone marrow edema (BME) in rock climbing athletes. DESIGN: Systematic detection, treatment, and follow-up investigation of rock climbing athletes with BME of the hand. SETTING: Primary-level orthopedic surgery and sports medicine division of a large academic medical center. PATIENTS: Thirty-one high-level climbers with diffuse pain in the hand and wrist joint caused by rock climbing were included in this study. INTERVENTIONS: The therapy consisted of consequent stress reduction and a break from sports. MAIN OUTCOME MEASURES: Reduction of BME shown through magnetic resonance imaging (MRI) and regaining of preinjury climbing levels (Union Internationale des Associations d' Alpinisme metric scale). RESULTS: In 28 patients, MRI revealed osseous edema because of overload at the respective area of interest, mainly in the distal radius, the distal ulna, or the carpal bones, which could not be otherwise diagnosed as inflammations, tumors, or injuries. We classified these edemas and fractures of the hamate because of overload. The edema was a stress reaction to highly intensive training and climbing with presumably high traction to the wrist area. The control MRIs demonstrated that even with a consequent stress reduction, the edemas required 3 to 4 months to disappear completely. CONCLUSIONS: Climbers with nonspecific, diffuse pain in the wrist and/or the fingers should be examined with MRI to detect or exclude the diagnosis of a BME.

[Three-dimensional architecture of intraosseous vascular anatomy of the hamate: a micro-computed tomography study].

OBJECTIVE: To obtain three-dimensional intraosseous artery of the hamate and to provide the vascular anatomy basis of hamate fracture fixation. METHODS: PbO (lead monoxide, Sinopharm Chemical Reagent Beijing Co. Ltd) was ground into particles less than 40 µm and suspended in turpentine oil (Chemical Reagent Beijing Co. Ltd) at ratios of 1 g : 1.5 mL, 1 g : 1 mL and 1 g : 0.5 mL. Three specimens were investigated. Brachial arteries were cannulated and perfused with lead-based contrast agent. Hamates were harvested and scanned using micro-computed tomography (microCT). The acquisition protocols were as follows: CT scan setup: total rotation [Degrees], 360; rotation steps, 360; X-ray detector setup: transaxial, 2048; axial, 2048; exposure time, 1 500 ms, Binning, 1; system magnification: high-med. X-ray tube setup: 80 kV, 500 mA current. The down-sampling factor used in the reconstruction was 2. The effective voxel size of the final image was 27.30 µm. The three-dimensional model of the hamate was generated and the distribution and pattern of vessels were evaluated. RESULTS: There were abundant extraosseous vessels around the hamate. They were mainly running in the tendons and ligaments around the hamate. Four vascular zones were identified on the hamate surface. They were on the palmar platform of the hamate body, on the dorsal side, on the ulnar side and on the tip of hamulus, namely. There were anastomoses among 4 vascular zones. We did not observe any vessels penetrating through the articular cartilage. The extraosseous vessels of the vascular zones gave a number of intraosseous branches into the hamate. The hamate body received intraosseous blood supply from the dorsal, palmar and ulnar while the hamulus from the palmar, ulnar and hamulus tip. There were some intraosseous branches anastomosing with each other. CONCLUSION: The extraosseous and intraosseous vessels of the hamate were more than what used to be considered. The hamate body and hamulus received blood supply from multiple directions and arteries anastomosed extensively both outside and inside the hamate, making it possible that the intraosseous perfusion survived after fracture. It is likely that the nonunion after the hamate fracture is not caused by the vascular damage but the malalignment of the fragments.

Hook of the Hamate: The Spectrum of Often Missed Pathologic Findings.

OBJECTIVE: The purposes of this article are to review hook of the hamate anatomy, describe the imaging features of the spectrum of pathologic conditions, and discuss the pearls and pitfalls of imaging for clinical decision making for pathologic entities affecting the hook of the hamate. CONCLUSION: Knowledge of the anatomy, imaging appearance, and clinical management of hook of the hamate abnormalities is important for radiologists in guiding the care of patients with ulnar-sided wrist symptoms.

Return to Play and Complications After Hook of the Hamate Fracture Surgery.

PURPOSE: The purpose of this study was to evaluate the efficacy of hook of the hamate excision for fracture in a large cohort of patients to better understand recovery time and complications. METHODS: We retrospectively reviewed the medical records of patients treated with surgical excision for hook of the hamate fractures at 2 different centers. We collected information on demographics, clinical presentation, and postoperative complications. Continuous outcome variables included time to surgery, return to play, and return to activity. RESULTS: Our cohort of 81 patients had a median age of 22 years and was composed of 74 athletes including 57 baseball players and 8 golfers. The median time to return to play was 6 weeks (range, 1-36 weeks) after surgery; 11 patients (14%) had a return at 12 weeks or longer. Seventy-eight patients returned to preinjury activity levels. Twelve patients with a full recovery continued to experience some level of intermittent, nonspecific pain in the affected hand, although this was not severe enough to require additional treatment. We observed a 25% incidence of postoperative complications with the majority consisting of transient ulnar nerve dysfunction. Complications were more common among nonathletes, those presenting with nonunions, and those experiencing longer intervals between injury and surgery. CONCLUSIONS: In most cases, surgical excision as treatment for hook of the hamate fractures is safe and allows a relatively rapid return to play. However, we found a higher incidence of complications, including transient ulnar nerve dysfunction, than has been previously reported. In addition, there is a group of patients with delayed return to play and continued discomfort after surgery. These findings should inform the discussion with surgical candidates. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Subtle radiographic signs of hamate body fracture: a diagnosis not to miss in the emergency department.

Hamate fractures are estimated to represent 1.7% of all carpal fractures and can occur at the hamulus (hook) or hamate body depending on mechanism of injury. Fractures of the hamate body can be exceedingly difficult to identify on standard wrist and hand radiographs in the emergency department. If the diagnosis is missed in the emergency department, orthopedic referral is often delayed. This can result in lasting functional disability for the patient, as these fractures have a propensity to destabilize the fourth and fifth carpometacarpal (CMC) joints. In this pictorial essay, we present six radiographic signs indicative of hamate body fracture with computed tomography (CT) imaging correlation. Injury mechanism and fracture classification schemes are portrayed to aid in the understanding of these injuries. Once radiographs raise suspicion for a hamate body fracture, further characterization with CT and orthopedic referral is paramount. Goals of orthopedic management include reestablishment of the fourth and fifth CMC articular surface, stabilization of the CMC joints, and appropriate treatment of concomitant soft tissue injury.

Patient with a Hook of the Hamate Fracture Presenting as Vascular Occlusion: Diagnosis Made with Bedside Ultrasound.

BACKGROUND: Hook of the hamate fractures are particularly rare carpal fractures with significant morbidity if not diagnosed early. Classically, these fractures occur from localized blunt trauma to the hook of the hamate in racket sports. Common complaints include pain localized in the hypothenar eminence and reduced grip strength. Hook of the hamate fractures have the potential to cause significant injury to the ulnar nerve and artery. CASE REPORT: We present the case of a 43-year-old man with hypothenar pain, paresthesias of the fifth finger and ulnar aspect of the fourth finger, and pallor of the fourth and fifth fingers. Using bedside ultrasonography, the patient was found to have a fracture of the hook of the hamate that was causing compression of the ulnar artery. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Fracture of the hook of the hamate is often not seen on x-ray studies, and fracture fragments can cause compression of adjacent structures, including the ulnar and median nerves and ulnar artery. Bedside ultrasound may be a useful adjunct in the diagnosis of this carpal fracture when standard x-ray studies do not show a fracture and clinical presentation is concerning for the diagnosis.

Pulling Harder than the Hamate Tolerates: Evaluation of Hamate Injuries in Rock Climbing and Bouldering.

OBJECTIVE: Hamate hook fractures are rare injuries, comprising 2% to 4% of all carpal fractures. Climbing athletes seem to be affected more frequently than others, as they strain the passive and active anatomical structures of their hands and fingers to maximum capacity during training or competing. This stress is transmitted to the hook of the hamate by tightened flexor tendons, which creates high contact pressure to the ulnar margin of the carpal tunnel. Injuries of the hamate hook, caused by contact pressure of the anatomical structures, are rare and occur nearly exclusively during climbing. METHODS: We diagnosed 12 athletes with hamate hook fractures who presented with diffuse pain in the wrist joint, which occurred either during or after climbing. Radiographs or computed tomography revealed fractures in the hamate bones in most of the patients; therapy consisted of consequent stress reduction. RESULTS: Follow-up investigations found that all athletes were free of symptoms after 10.7 ± 5.1 (6-24) (mean ± standard deviation with range) weeks. Resection of the hamate hook was necessary in 3 patients. All patients regained their preinjury climbing level. CONCLUSION: Climbers with an unspecific, diffuse pain in the wrist need to be examined by radiograph and, if radiograph is unclear, computed tomography or magnetic resonance imaging to detect or exclude the diagnosis of hamate fracture in order to avoid severe complications.

[Ulnar-sided wrist pain in sports: TFCC lesions and fractures of the hook of the hamate bone as uncommon diagnosis]. / Ulnarer Handgelenkschmerz beim Schlagsport: TFCC-Läsionen und Frakturen des Hamulus ossis hamati als seltene Diagnosen.

Injuries to the hand and wrist are common sports injuries. The diagnosis and therapy of wrist injuries are becoming more important, especially in increasingly more popular ball-hitting sports, such as golf, tennis and baseball. Ulnar-sided wrist pain is initially often misdiagnosed and treated as tenosynovitis or tendinitis but tears of the triangular fibrocartilage complex (TFCC) and fractures of the hook of hamate bone, which can also occur in these sports are seldomly diagnosed. The aim of this study was to conduct a systematic review of the literature focussing on TFCC lesions and fractures of the hook of the hamate bone in racquet sports, baseball and golf. A systematic review of the literature was performed in PubMed on the occurrence of TFCC lesions and fractures of the hook of the hamate bone. All studies and case reports were included. Because of the rarity of these injuries there were no exclusion criteria concerning the number of cases. Injuries associated with ball-hitting sports, such as TFCC lesions and fractures of hook of the hamate bone are still underrepresented in the current literature on sports injuries. The diagnosis and treatment of these injuries are often delayed and can severely handicap the performance and career of affected professional as well as amateur athletes.

Stress fracture of the hook of the hamate: a case report.

Hook of the hamate fractures are uncommon. This fracture is usually seen in sports involving a club or a racquet (i.e., baseball or golf) and is caused by blunt trauma. Stress fractures of the hamate are exceedingly rare. Because of its subcutaneous position and associated soft tissue structures, hook of the hamate fractures can be difficult to diagnosis. When treated early, conservative (non-operative) options can be used to successfully treat the fracture. When the diagnosis is delayed, nonunion of the fracture is common and is usually treated with surgery. This case represents a hook of the hamate stress fracture that healed with casting in spite of being seen two months from the onset of symptoms. Hamate fractures are reviewed, including the anatomy and treatment options for hook of the hamate fractures.

Fifth carpometacarpal fracture dislocations fixed with Meta-HUS®: a series of 31 cases.

Fracture dislocations of the fifth carpometacarpal are usually treated by percutaneous K-wires despite occasional complications: displacement, stiffness, malunions, and arthritis. Our aims were to evaluate the use of locked K-wire fixation for these fracture dislocations. Our series includes 31 fracture dislocations, five extra-articular and 26 articular, 21 of which were at the base of the metacarpal, four at the hamate, and one involving both the hamate and the metacarpal. Mean tourniquet time was 22 min and irradiation 2 mGy. After reduction, an M4 M5 K-wire and a carpometacarpal wire were connected using an MetaHUS® connector. Immediate immobilization was allowed. Return to normal activity was resumed at 6.5 weeks. At around 15 months follow-up, mean pain score was 8.5, Quick DASH was 6.36, and overall grip strength was 92%, TAM of the fifth ray was 96% of the contralateral side. There were two displacements that were re-operated with good result, three superficial infections, and one case of stiffness. All fractures healed without arthritis. Overall, percutaneous K-wire and splinting of fracture dislocations of the fifth carpometacarpal joint is unstable, and internal fixation can cause adhesions and stiffness. Our results show that the percutaneous locked K-wire technique is a good alternative as it associates closed reduction with K-wire fixation and a solid fixation using an external connector. This technique allows immediate mobilization of the hand and removal of hardware in clinic.